MAYO CLINIC

I just turned 50, and my health care provider recommends that I get a colonoscopy to screen for colon cancer. I want to have the test done, but as a recovering addict, I don't want pain medication. Is this possible, or would the pain be too much? What are my other options?

ANSWER: For people in your situation, there are several alternatives to choose from when considering a colonoscopy. In addition to the option of forgoing pain medication completely, you could have the procedure with nonnarcotic medication, or you may be able to opt for a noninvasive colorectal cancer screening test instead of a colonoscopy.

A colonoscopy is an exam used to detect changes or abnormalities in the colon and rectum. This test often is recommended as a screening exam for colon cancer, beginning at age 50, for people who have no colon cancer risk factors other than age. During a colonoscopy, a long, flexible tube, called a colonoscope, is inserted into the rectum. A tiny video camera at the tip of the tube enables your health care provider to view the inside of the entire colon.

Although sedatives and pain medications may be used to minimize discomfort during a colonoscopy, it is possible to have a colonoscopy without pain medication or sedatives. That is often the way a colonoscopy is performed outside the U.S.

When patients want to try colonoscopy without pain medication or sedation, they usually have the option for an IV line to be placed before the procedure starts. That way, the care team can give medication promptly through the IV if the procedure becomes intolerable. The medication you receive in that case could be one that doesn't contain a narcotic. This would avoid your addiction concerns.

It is also possible to have a colonoscopy performed under monitored anesthesia care. In that setting, a nurse anesthetist administers only sedation medication during the procedure. Here, too, you can request that the medication you receive not include a narcotic.

Another option would be a noninvasive colorectal cancer screening test, such as the stool DNA test (Cologuard). That test looks for abnormal DNA associated with colon cancer or colon polyps. The test also detects hidden blood in the stool, which can indicate the presence of cancer. This test is intended for colon cancer screening in people who don't have symptoms. It's not a viable option if a colonoscopy is being ordered to evaluate symptoms or for people who have a strong family history of colon cancer, particularly a history that suggests a hereditary pattern. It also should be noted that if the stool DNA test is positive, a colonoscopy would be required to check for polyps or colon cancer.

An additional noninvasive option is a virtual colonoscopy, sometimes called a screening CT colonography. Unlike a traditional colonoscopy, a virtual colonoscopy uses a CT scan instead of a colonoscope to produce images of your abdominal organs. The images are combined and digitally manipulated to provide a detailed view of the inside of the colon and rectum. Sedation and pain medications aren't necessary for this test. Be aware, though, that not all health insurance providers pay for virtual colonoscopy for colon cancer screening. Check with your insurance provider before having this procedure to find out if it's covered.

In addition to the tests discussed here, you may have other choices for colon cancer screening, too, depending on your situation. Talk to your health care provider about your options. There are ways to comply with your preference for avoiding narcotic pain medications while still obtaining this important cancer screening. - John Kisiel, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.