Colonoscopy and the psyche – pain and discomfort associations with affect and cognitive functions

Adam Zaczek; Anna Pietrasińska-Wojna; Anna Szczegielniak; Katarzyna Girczys-Połedniok; Paweł Dębski; Robert Pudlo

doi:10.12923/2353-8627/2024-0002

Authors

Adam Zaczek Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland Author https://orcid.org/0000-0002-0650-9567
Anna Pietrasińska-Wojna Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland Author
Anna Szczegielniak Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland Author https://orcid.org/0000-0002-2160-4589
Katarzyna Girczys-Połedniok Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland Author
Paweł Dębski Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland Author https://orcid.org/0000-0001-5904-6407
Robert Pudlo Department of Psychoprophylaxis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland Author https://orcid.org/0000-0002-5748-0063

DOI:

https://doi.org/10.12923/2353-8627/2024-0002

Keywords:

psychiatry, colonoscopy, pain, emotions, cognitive function

Abstract

Introduction: Colonoscopy is an important diagnostic and therapeutic procedure, however it causes considerable discomfort in patients. Their psychological functioning is sometimes not sufficiently taken into account by the medical staff, preoccupied with somatic conditions. The aim of this study was to reveal affective and cognitive aspects of how patients undergoing colonoscopy function in order to better understand periprocedural discomfort and pain and suggest interventions to reduce them.

Material and methods: A total number of 101 patients, undergoing colonoscopy during their stay at the internal ward, were asked to participate in this prospective, observational study. Three measurements were made: the day before the examination, on the colonoscopy day (after bowel cleansing, before the procedure) and the following day. The State-Trait Anxiety Inventory, Beck Depression Inventory II, Montreal Cognitive Assessment, short version of The Illness Perceptions Questionnaire , as well as analog scales (measuring pain, sadness, anxiety, irritability, general discomfort and distress) were used. Ultimately, 50 people completed the study.

Results: It has been shown that pain and discomfort on the colonoscopy day correlate positively with all measured aspects of negative affect. On the colonoscopy day 18% of the subjects revealed depressive symptoms matching a depressive episode, while 56.6% of the subjects displayed a high level of state anxiety. The worse the patient's understanding of the disease, the more periprocedural pain he/she experiences. Their cognitive functioning is worse on the colonoscopy day.

Conclusions: The results suggest that it is advisable to educate patients early enough (not on the day of the procedure) about their ailments and planned colonoscopy.

References

1. Tárraga López PJ, Albero JS, Rodríguez-Montes JA. Primary and secondary prevention of colorectal cancer. Clin Med Insights Gastroenterol. 2014;7:33-46. Review match

2. Kaminski MF, Robertson DJ, Senore C, Rex DK. Optimizing the Quality of Colorectal Cancer Screening Worldwide. Gastroenterology. 2020;158(2):404-417. Review match

3. Shafer LA, Walker JR, Waldman C, Yang C, Michaud V, Bernstein CN, et al. Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings. Dig Dis Sci. 2018;63(3):610-618. Review match

4. McEntire J, Sahota J, Hydes T, Trebble TM. An evaluation of patient attitudes to colonoscopy and the importance of endoscopist interaction and the endoscopy environment to satisfaction and value. Scand J Gastroenterol. 2013;48(3):366-373. Review match

5. Greenspan M, Chehl N, Shawron K, Barnes L, Li H, Avery E, et al. Patient on-adherence and Cancellations Are Higher for Screening Colonoscopy Compared with Surveillance Colonoscopy. Dig Dis Sci. 2015;60(10):2930-2936. Review match

6. Janiak M., Głowacka P, Kopeć A, Staśkiewicz A. Factors determining attendance rate to colonoscopy in National Screening Programme in Poland. Gastroenterol Klin. 2016;8(4):142-151.

7. Ko SY, Leung DY, Wong EM. Effects of easy listening music intervention on satisfaction, anxiety, and pain in patients undergoing colonoscopy: a pilot randomized controlled trial. Clin Interv Aging. 2019;14:977-986. Review match

8. Lee J, Lee E, Kim Y, Kim E, Lee Y. Effects of gum chewing on abdominal discomfort, nausea, vomiting and intake adherence to polyethylene glycol solution of patients in colonoscopy preparation. J Clin Nurs. 2016;25(3-4):518-525. Review match

9. Trevisani L, Zelante A, Sartori S. Colonoscopy, pain and fears: Is it an indissoluble trinomial? World J Gastrointest Endosc. 2014;6(6):227-233. Review match

10. Cao J, Ding L. Psychosomatic practice in gastroenterology: new insights and models from China. Psychother Psychosom. 2019;88:321-6. Review match

11. Koloski N, Holtmann G, Talley NJ. Is there a causal link between psychological disorders and functional gastrointestinal disorders? Expert Rev Gastroenterol Hepatol. 2020;14(11):1047¬1059.

12. Review match 12. Parker J, Kennedy P. Factors predictive of distress in people awaiting a lower gastro-intestinal endoscopy. Psychol Heal Med. 2010;15(1):26-33. Review match

13. Liu YY, Liu YQ, Petrini MA. Effect of information of patients’ coping style on pregastroscopy anxiety. Gastroenterol Nurs. 2018;41(1):47-58. Review match

14. Cheng Y, Zhong C, Wu W, Xi X, Luo M, Chen Y, et al. Association between anxiety, depression, and bowel air bubbles at colonoscopy: A prospective observational study. Ann Palliat Med. 2021;10(3):3247-3257. Review match

15. Shafer LA, Walker JR, Waldman C, Michaud V, Yang C, Bernstein CN, et al. Predictors of patient reluctance to wake early in the morning for bowel preparation for colonoscopy: a precolonoscopy survey in city-wide practice. Endosc Int Open. 2018;6(6):E706-E713. Review match

16. Lee YJ, Kim ES, Park KS, Cho KB, Jang BK, Chung WJ, et al. Education for Ward Nurses Influences the Quality of Inpatient’s Bowel Preparation for Colonoscopy. Medicine (Baltimore). 2015;94(34):e1423. Review match

17. Coombes JM, Steiner JF, Bekelman DB, Prochazka AV, Denberg TD. Clinical Outcomes Associated with Attempts to Educate Patients about Lower Endoscopy: A Narrative Review. J Community Health. 2008;33(3):149-157. Review match

18. Hallegraeff JM, van Trijffel E, Kan RW, Stenneberg MS, Reneman MF. Illness perceptions as an independent predictor of chronic low back pain and pain-related disability: a prospective cohort study. Physiotherapy. 2021;112,72-77. Review match

19. Tan MN, Limnili G, Yıldırım E, Güldal AD. To understand or not to understand: This is the problem. Turk J Gastroenterol. 2018;29(6):642-649.

20. Crawford J, Cayley C, Lovibond PF, Wilson PH, Hartley C. Percentile Norms and Accompanying Interval Estimates from an Australian General Adult Population Sample for Self-Report Mood Scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Aust Psychol. 2011;46(1):3-14. Review match

21. Sosnowski T, Wrześniewski K, Jaworowska A, Fecenec D. Inwentarz Stanu i Cechy Lęku, polska adaptacja STAI [The Polish adaptation of the State-Trait Anxiety Inventory (STAI)]. Warszawa: Pracownia Testów Psychologicznych PTP; 2011.

22. Jackson-Koku G. Beck depression inventory. Occup Med (Lond). 2016;66(2):174-175.

23. Zawadzki B, Popiel A, Pragłowska E. Charakterystyka psychometryczna polskiej adaptacji Kwestionariusza Depresji BDI-II Aarona T. Becka [Psychometric Properties of the Polish Version of the Aaron T. Beck’s Depression Inventory BDI-II]. Psychol Etol Genet. 2009;19:71-95.

24. Hobson J. The Montreal Cognitive Assessment (MoCA). Occup Med (Lond). 2015;65(9):764-765.

25. Gierus J, Mosiołek A, Koweszko T, Kozyra O, Wnukiewicz P, Łoza B, et al. Montrealska Skala Oceny Funkcji Poznawczych MoCA 7.2.-polska adaptacja metody i badania nad równoważnością [The Montreal Cognitive Assessment 7.2-Polish adaptation and research on equivalency]. Psychiatr Pol. 2015;49(1):171-179. Review match

26. Broadbent E, Wilkes C, Koschwanez H, et al. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Heal. 2015;30(11):1361-1385. Review match

27. Nowicka-Sauer K, Banaszkiewicz D, Staśkiewicz I, Kopczyński P, Hajduk A, Czuszyńska Z, et al. Illness perception in Polish patients with chronic diseases: Psychometric properties of the Brief Illness Perception Questionnaire. J Health Psychol. 2016;21(8):1739-1749. Review match

28. Ownby KK. Use of the distress thermometer in clinical practice. J Adv Pract Oncol. 2019;10(2):175-179.

29. Car J, Zycińska J, Lasota W. Ocena dystresu i depresji u osób chorych na nowotwory złosliwe [Assessment of psychological distress and depression in cancer patients]. Przegl Epidemiol. 2012;66(4):689-695.

30. Wiech K, Tracey I. The influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage. 2009;47:987-94. Review match

31. Xiao X, Zhang YQ. A new perspective on the anterior cingulate cortex and affective pain. Neurosci Biobehav Rev. 2018;90:200-11.

32. Strobel C, Hunt S, Sullivan R, Sun J, Sah P. Emotional regulation of pain: The role of noradrenaline in the amygdala. Sci China Life Sci. 2014;57:384-390. Review match

33. Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet. 2020;396:1675-1688. Review match

34. Li S, Hua D, Wang Q, Yang L, Wang X, Luo A. The role of bacteria and its derived metabolites in chronic pain and depression: Recent findings and research progress. Int J Neuropsychopharmacol. 2020;23:26-41. Review match

35. Wilson-Barnett J. Psychological reactions to medical procedures. Psychother Psychosom. 1992;57(3):118-27.

36. Daniel E. Music used as anti-anxiety intervention for patients during outpatient procedures: A review of the literature. Complement Ther Clin Pract. 2016;22:21-23.

37. Yang C, Sriranjan V, Abou-Setta AM, Poluha W, Walker JR, Singh H. Anxiety associated with colonoscopy and flexible sigmoidoscopy: a systematic review. Am J Gastroenterol. 2018;113(12):1810-1818. Review match

38. Chludzinski A, Irani C, Mascha EJ, Kurz A, Devereaux PJ, Sessler DI. Protocol understanding and anxiety in perioperative clinical trial patients approached for consent on the day of surgery. Mayo Clin Proc. 2013;88(5):446-454. Review match

39. Park J, Moghaddam B. Impact of anxiety on prefrontal cortex encoding of cognitive flexibility. Neuroscience. 2017;345:193-202. Review match

40. Wadsworth P, Blackburne H, Dixon L, Dobbs B, Eglinton T, Ing A, et al. Does Bowel Preparation for Colonoscopy Affect Cognitive Function? Medicine (Baltimore). 2015;94(44):e1823. Review match

41. Stamenkovic DM, Rancic NK, Latas MB, Neskovic V, Rondovic GM, Wu JD, et al. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiol. 2018;84:1307-1317. Review match

42. Ackland GL, Harrington J, Downie P, Holding JW, Singh-Ranger D, Griva K, et al. Dehydration induced by bowel preparation in older adults does not result in cognitive dysfunction. Anesth Analg. 2008;106(3):924-929. Review match

43. Antunovich DR, Horne JC, Tuck NL, Bean DJ. Are Illness Perceptions Associated with Pain and Disability in Complex Regional Pain Syndrome? A Cross-Sectional Study. Pain Med. 2021;22:100-111. Review match

44. Azulay R, Valinsky L, Hershkowitz F, Magnezi R. CRC screening results: Patient comprehension and follow-up. Cancer Control. 2019;26(1):1073274819825828. Review match

Colonoscopy and the psyche – pain and discomfort associations with affect and cognitive functions

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