Is a Non Verbal Pain Assessment Tool a Reliable Method of Assessing Pain during Colonoscopy?

Abstract

Purpose: To determine whether a Non Verbal Pain Assessment Tool (NVPAT) composed of 5 variables (emotion, movement, verbal cues, facial cues and position) is an accurate and reliable predictor of patient pain during colonoscopy under conscious sedation; as opposed to the more traditional methods of pain rating such as the numerical pain rating scale or facial pain scale. Methods: Inpatient and outpatient colonoscopies at our facility between 3/1/09 and 6/1/09 (n=372) were retrospectively reviewed. The average pain score reported by our endoscopy nurses during the procedure for patients with known risk factors for painful colonoscopies were compared to patients without the risk factors. The risk factors for a more painful colonoscopy were obtained from current literature and include women with a low BMI, younger patients, women status post hysterectomy, poor bowel preparation and caucasian race. The literature also suggests that further indicators of painful colonoscopy include changing a patient's position, a longer time taken to reach the cecum or the application of abdominal pressure during colonoscopy. Our data was also expanded to include endoscopist experience (fellows in training vs. attending physicians) and endoscope diameter (adult vs. pediatric scope). Results: No significant age difference was noted between male and female genders. Nonetheless, pain perception was noted to be greater in women when compared to men (p=0.006) using the NVPAT. When fellows in training were compared to attending physicians, the difference in the NVPAT score was not significant (p=0.095). However, the time taken to reach the cecum had a statistically significant difference in NVPAT score (p=0.002). Age of the patient, BMI, personal history of intra-abdominal surgeries, indications for colonoscopy, bowel preparation, scope diameter and completion of colonoscopies did not significantly affect the NVPAT score. However, patients who had to be repositioned for the procedure did have a significantly higher score based on the NVPAT (p=0.006). Upon assigning scoring (one point each to the risk factors for painful colonoscopy outlined above), the NVPAT score was higher in patients with more risk factors (p=0.016). Conclusion: A NVPAT can be used as a reliable tool to quantify patient pain during colonoscopy under conscious sedation. However, given the very subjective nature of pain and the inherent complications in objectively quantifying it, further research is needed to determine more accurate and reliable predictors of patient pain during endoscopy, so as to maximize patient comfort during these procedures.