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Aim: The study aims to develop a protocol for the combined use of swaddling, facilitated tucking, expressed breast milk and sucrose administration methods in the orogastric tube (OGT) insertion procedure and evaluate its effectiveness. Methods: The randomized controlled trial was conducted in the Neonatal Intensive Care Unit between 15 February 2022 and 15 September 2022, with 175 preterms. Preterms at 32–34 gestational weeks were randomly allocated to five groups: routine care, swaddling + expressed breast milk, swaddling + sucrose, facilitated tucking + expressed breast milk and facilitated tucking + sucrose groups. The data were collected using the Preterm Descriptive Information Form, the Physiological Measurement Form, the COMFORTneo scale and the Premature Infant Pain Profile (PIPP). Results: The facilitated tucking + expressed breast milk method was found to be more effective than the routine care (pdistress < 0.001; ppain = 0.031) and swaddling + expressed breast milk (pdistress = 0.004; ppain = 0.015) methods in reducing the estimated distress and PIPP pain level of preterms during the procedure. Two minutes after the procedure, the facilitated tucking + expressed breast milk method was more effective than the routine care (p < 0.001), swaddling + expressed breast milk (p = 0.011) and swaddling + sucrose (p = 0.002) methods in reducing the comfort level score. Conclusions: The facilitated tucking + expressed breast milk method is effective in reducing pain and distress and providing comfort during the OGT procedure. Clinical Trials ID: NCT05180058. Summary statement: What is already known about this topic? As there is a paucity of evidence‐based literature on the management of OGT, which is a painful procedure, the management of this pain becomes even more crucial, especially in preterms whose development and complication mechanisms are not completed.There are conflicting results in the literature regarding the effectiveness of expressed breast milk and sucrose, so this study is believed to serve as a research topic for further studies. What this paper adds? The highest mean heart rate, the lowest oxygen saturation, the highest estimate of pain and distress level and the highest comfort and pain score averages of the neonates were found during the procedure, indicating that the OGT procedure is painful.The facilitated tucking + expressed breast milk method was effective in decreasing the estimate of distress and the pain level of newborns during the procedure, decreasing the estimate of pain and distress values 1 min after the procedure and decreasing the comfort level score 2 min after the procedure. The implications of this paper: This study, comparing the effectiveness of using expressed breast milk and sucrose in combination with swaddling and facilitated tucking and developing an application protocol, provides an easy‐to‐use nursing practice for preterm pain management.The protocol was developed for combined swaddling, facilitated tucking, expressed breast milk and sucrose administration, and its effectiveness was evaluated.The facilitated tucking + expressed breast milk method may help nurses as a supportive method in pain management. [ABSTRACT FROM AUTHOR]