Comparison of no medication, placebo, and hyoscyamine for reducing pain during a barium enema

OBJECTIVE, We carried out a prospective, randomized study to evaluate the u sefulness of premedication with an oral anticholinergic for relief of pain during and after a barium enema of the colon. SUBJECTS AND METHODS, Patients were randomized into three groups: no medica tion, placebo, and sublingual l-hyoscyamine sulfate. The placebo or hyoscya mine tablet was placed under the tongue 15-30 min before the examination. A fter the procedure the patients were interviewed. An analog scale (0-10) wa s used to score the level of pain that the patients experienced during the examination. Forty-eight hours after the examination, the patients returned by mail a survey that used the same scale and asked about delayed pain. RESULTS. Data from 110 patients were studied. Sixty-nine patients were wome n, and 41 were men. They ranged from 24 to 82 years old (mean, 55 years). F or the no-medication group (n = 36), the mean pain score was 4.1; for the p lacebo group (n = 34), 3.8; and for the hyoscyamine group (n = 40), 4.2. No statistically significant difference in pain scores was found be tween any groups (p = .72). Six patients from each group reported minor side effects . The mean scores from the returned surveys (n = 79) were 3.8 for the no-me dication group (n = 26) and placebo group (n = 22) and 3.1 for the hyoscyam ine group (n = 31). No statistically significant difference was found betwe en any of these groups (p = .48) or between delayed pain responses and init ial pain responses (p = .27). CONCLUSION. Although safe, hyoscyamine seems to provide no benefit over no drug or a placebo when used as a pain premedication for patients undergoing a barium enema.