NSAIDs Better than Opioids for Acute Pain from Kidney Stones

By Will Boggs MD

NEW YORK (Reuters Health) - In patients with acute renal colic, nonsteroidal anti-inflammatory drugs (NSAIDs) provide more sustained pain relief with fewer side effects than opioids, according to a systematic review and meta-analysis.

"For young patients presenting with renal colic symptoms and not known to have renal impairment or contraindications to NSAIDs, intramuscular diclofenac (NSAID) should be the first line of analgesia,” Dr. Sameer A. Pathan from Hamad General Hospital, Doha, Qatar, and Monash University, Melbourne, Australia, told Reuters Health by email. “If there are contraindications to NSAID use or for patients who do not experience sustained pain relief after initial dose of intramuscular NSAID, rescue intravenous analgesia, such as paracetamol (acetaminophen) or titrated-dose opioid can be used to treat renal colic.”

NSAIDs have been recommended as the first-line analgesic in patients with severe pain from renal colic, but many clinicians continue to prefer opioid treatment.

Dr. Pathan and colleagues compared the efficacy and safety of NSAIDs against opioids or acetaminophen for managing acute renal colic in a systematic review of 36 randomized controlled trials involving 4,887 patients from 16 countries. The findings were published online November 21 in European Urology.

Compared with opioids, NSAIDs provided only a marginal benefit in terms of 0-100 pain measures (converted from patient-reported pain scores) but a significantly lower requirement for rescue analgesia (relative risk, 0.73).

The two types of treatments did not differ in providing complete or at least 50% pain relief at 30 minutes.

Patients treated with NSAIDs were 47% less likely to have an adverse event and 59% less likely to experience vomiting, compared to opioid-treated patients.

Acetaminophen was similar to NSAIDs in pain measures, treatment-related adverse events, and vomiting rates, but the need for rescue analgesia was greater with acetaminophen than with NSAIDs.

The quality of evidence was very low for pain measures, low for rescue analgesia, and moderate for vomiting rates. Only the evidence for NSAID benefit over acetaminophen for the requirement of rescue treatments was of high quality.

“We need large trials to be conducted under robust methodology and adherence to patient-centered outcomes,” Dr. Pathan said.

SOURCE: https://bit.ly/2j3nS9t

Eur Urol 2017.

(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp

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