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已发表论文
结肠镜检查期间镇痛的药物、非药物及联合策略的比较有效性：一项随机试验的贝叶斯网络荟萃分析
Authors Huang X , Tian S , Xu L, Chen J, Wang H, Mai T , Shi L, Wang H, Cai M, Fang F
Received 23 July 2025
Accepted for publication 12 November 2025
Published 19 November 2025 Volume 2025:18 Pages 6165—6179
DOI https://doi.org/10.2147/JPR.S554665
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Robert B. Raffa
Xiaonan Huang,1,* Shan Tian,2,* Lifan Xu,1,* Juhan Chen,1,* Hao Wang,3 Tingting Mai,1 Lei Shi,1 Han Wang,4 Mengcheng Cai,5 Fanfu Fang1
1Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China; 2Department of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 3Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China; 4School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China; 5Department of Rehabilitation Medicine, Naval Medical Center, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Fanfu Fang, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, People’s Republic of China, Email fangfanfu@126.com Mengcheng Cai, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, People’s Republic of China, Email caimengcheng@126.com
Background: Colonoscopy is the gold standard for colorectal cancer screening, but procedural pain remains a major barrier to patient compliance. Various pharmacological and non-pharmacological interventions have been developed to improve patient comfort, yet the comparative effectiveness of these strategies remains unclear.
Methods: We systematically searched five databases for randomized controlled trials published between 2004 and 2024 that evaluated analgesic interventions for colonoscopy and performed a Bayesian random-effects network meta-analysis. We analyzed two pre-specified subnetworks—non-pharmacological and pharmacological/combined—according to intervention type. The primary outcome was pain on a visual analogue scale.
Results: 40 RCTs (5614 participants, 32 interventions) were included. Compared to blank control: 1) Combined physical intervention + analgesia/sedation (MD = − 2.7, 95% CrI: − 5.3 to − 0.15) and water perfusion/CO2 insufflation (MD = − 1.9, 95% CrI: − 2.8 to − 0.99) significantly reduced pain; 2) Among non-pharmacological interventions, CO2 insufflation, water perfusion, and visual distraction showed significant advantages; 3) Among pharmacological/combined interventions, pethidine + benzodiazepines + non-pharmacological (MD = − 5.1, 95% CrI: − 8.6 to − 1.7) and propofol-based strategies were most effective. SUCRA rankings identified combined physical intervention + analgesia/sedation, propofol, and water perfusion/CO2 as top overall interventions.
Conclusion: Multimodal strategies that combine pharmacological agents, especially pethidine or propofol, with non-pharmacological techniques such as CO2 insufflation and water perfusion provide the most effective pain relief during colonoscopy.
Keywords: colonoscopy, pain relief, network meta-analysis, nonpharmacologic interventions, randomized controlled trials
1Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China; 2Department of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 3Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China; 4School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China; 5Department of Rehabilitation Medicine, Naval Medical Center, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Fanfu Fang, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, People’s Republic of China, Email fangfanfu@126.com Mengcheng Cai, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, People’s Republic of China, Email caimengcheng@126.com
Background: Colonoscopy is the gold standard for colorectal cancer screening, but procedural pain remains a major barrier to patient compliance. Various pharmacological and non-pharmacological interventions have been developed to improve patient comfort, yet the comparative effectiveness of these strategies remains unclear.
Methods: We systematically searched five databases for randomized controlled trials published between 2004 and 2024 that evaluated analgesic interventions for colonoscopy and performed a Bayesian random-effects network meta-analysis. We analyzed two pre-specified subnetworks—non-pharmacological and pharmacological/combined—according to intervention type. The primary outcome was pain on a visual analogue scale.
Results: 40 RCTs (5614 participants, 32 interventions) were included. Compared to blank control: 1) Combined physical intervention + analgesia/sedation (MD = − 2.7, 95% CrI: − 5.3 to − 0.15) and water perfusion/CO2 insufflation (MD = − 1.9, 95% CrI: − 2.8 to − 0.99) significantly reduced pain; 2) Among non-pharmacological interventions, CO2 insufflation, water perfusion, and visual distraction showed significant advantages; 3) Among pharmacological/combined interventions, pethidine + benzodiazepines + non-pharmacological (MD = − 5.1, 95% CrI: − 8.6 to − 1.7) and propofol-based strategies were most effective. SUCRA rankings identified combined physical intervention + analgesia/sedation, propofol, and water perfusion/CO2 as top overall interventions.
Conclusion: Multimodal strategies that combine pharmacological agents, especially pethidine or propofol, with non-pharmacological techniques such as CO2 insufflation and water perfusion provide the most effective pain relief during colonoscopy.
Keywords: colonoscopy, pain relief, network meta-analysis, nonpharmacologic interventions, randomized controlled trials