Introduction Colonoscopy is generally perceived as being a painful procedure. Nonetheless, pain is a rather subjective experience for individuals and can be multifactorial. The aim of this study was to identify the predictors of pain during colonoscopy.

Methods 1824 consecutive colonoscopies performed in 2010 were identified. Data was retrospectively collected on gender, patients’ medical co-morbidities, type and effectiveness of bowel preparation, medication used during the procedure, endoscopist’s performance and endoscopic findings such as presence of diverticular disease. Logistic regression analysis was used to identify independent predictors of pain during the procedure.

Results Male patients were found to be less likely to develop pain during colonoscopy (odds ratio (OR) 0.43, 95% CI 0.35–0.53, p < 0.001). Those who had any malignancy in the past (OR 0.69, 95% CI 0.49–0.97, p = 0.02) and previous abdominal surgery (OR 0.63, 95% CI 0.47–0.84, p = 0.02) were less prone to having pain. Better bowel preparation improved the comfort of the procedure (OR 0.67, 95% CI 0.54–0.85, p = 0.001) however those who used Moviprep as bowel preparation were more likely to complain of pain (OR 1.83, 95% CI 1.34–2.49, p < 0.001). Higher dose of pethidine requirement was found to be associated with increase likelihood of reporting pain (OR 1.03, 95% CI 1.02–1.04, p < 0.001) but no association was found with the use of midazolam or buscopan. High performance endoscopists were found to cause less pain (OR 0.35, 95% CI 0.27–0.46, p = p < 0.001). The presence of diverticular disease showed a strong trend towards increasing probability of pain although it did not reach statistical significance (OR1.4, 95% CI 1.1–1.8, p = 0.07). Age and medical co-morbidities like rheumatological and neurological problems did not have any significant association.

Conclusion Likelihood of having abdominal pain during colonoscopy was found to be associated with being female, having poor bowel preparation and the procedure being performed by non-high performing endoscopists. Patients with past history of malignancy were also noted to have less tendency of having pain. The association of higher dose of pethidine and reported pain was likely to reflect the need of larger doses in such situation. Interestingly, history of previous abdominal surgery did not increase the likelihood of reporting pain and in fact had the opposite effect. The reason for why patients who had Moviprep as bowel preparation were more likely to complain of pain is unknown and this may need to be explored in future studies.

Disclosure of Interest None Declared.