From the Guidelines
The management of renal colic (kidney stones pain) should prioritize increased fluid intake, pain management with medications such as ibuprofen or naproxen, and consideration of pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol for patients with active disease. The goal of management is to reduce morbidity, mortality, and improve quality of life by preventing recurrent nephrolithiasis and addressing the underlying causes of stone formation. Key considerations include:
- Increasing fluid intake to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis, as recommended by the American College of Physicians (ACP) 1.
- Using over-the-counter medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg initially, then 250mg every 6-8 hours) for mild to moderate pain, and prescription medications such as ketorolac (30mg IV or 10mg orally every 6 hours) or opioids like hydrocodone/acetaminophen (5-10mg/325mg every 4-6 hours) for severe pain.
- Considering pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones, as recommended by the ACP 1.
- Staying hydrated by drinking 2-3 liters of water daily to help flush out stones and prevent dehydration.
- Applying heat to the affected area using a heating pad set at a moderate temperature for 15-20 minutes to provide additional relief. It is essential to seek medical attention immediately for severe pain unresponsive to medication, fever, vomiting, or inability to urinate, as these symptoms may indicate complications requiring urgent intervention 1. The management of renal colic should be guided by the most recent and highest-quality evidence, prioritizing the single most recent and highest-quality study available 1.
From the Research
Management of Renal Colic
The management of renal colic, or kidney stones pain, involves several approaches to alleviate pain and address the underlying condition.
- Pain management is a key aspect of renal colic treatment, with various medications and non-pharmacological interventions available 2, 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are commonly used for pain relief in renal colic, with NSAIDs generally having a better safety profile 4, 2.
- According to a study, morphine can provide greater pain relief than acetaminophen, but it is also associated with more complications such as dizziness and hypotension 4.
- Another study found that the combination of morphine and an NSAID can provide greater analgesic effect than either agent used alone in about 10% of patients 2.
- Paracetamol (acetaminophen) can be an effective and safer alternative for patients with renal colic pain, especially for those with certain medical conditions or taking other medications 5, 4.
Medication Trends
- A recent study found that opioid use for kidney stone pain management in United States emergency departments decreased significantly from 2015 to 2021, while NSAID use remained stable 6.
- The same study found regional variation and disparities in discharge prescriptions for Black and female patients, highlighting the need for continued efforts to improve opioid stewardship 6.
- Medications such as alpha blockers, thiazide diuretics, allopurinol, and citrates may be prescribed for patients with recurrent kidney stones or certain underlying conditions 3.
Non-Pharmacological Interventions
- Local active warming, such as applying heat to the abdomen or lower back, can be an effective non-pharmacological intervention for renal colic pain relief 2.
- Lifestyle modifications, including increased fluid intake, can help prevent kidney stone recurrence and are recommended for all patients with kidney stones 3.