From the Guidelines
The most effective treatment for kidney stone pain is a combination of pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) and medical expulsive therapy using alpha-blockers, such as tamsulosin, to facilitate stone passage. For immediate pain relief, NSAIDs like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg initially, then 250mg every 6-8 hours) are first-line options, as they have been shown to be effective in reducing pain associated with kidney stones 1. In cases of severe pain, prescription medications such as ketorolac (30mg IV or 10mg orally every 6 hours) or, in extreme cases, opioid analgesics like morphine may be necessary. Alpha-blockers, specifically tamsulosin (0.4mg daily), have been found to be the preferred agents for medical expulsive therapy, as they facilitate ureteral stone passage by relaxing ureter muscles, with a statistically significant 29% more patients passing their stones compared to control patients 1. Additionally, drinking plenty of fluids (2-3 liters daily) helps flush out smaller stones, and a warm compress applied to the affected area can provide additional comfort. It is essential to note that medical expulsive therapy is typically used for stones smaller than 10mm, while larger stones may require procedures like extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy. Pain from kidney stones occurs when the stone moves and stretches the ureter, triggering nerve endings and causing intense discomfort, and prompt medical attention is essential if pain is accompanied by fever, vomiting, or inability to urinate, as these may indicate complications requiring immediate intervention. Key points to consider in the treatment of kidney stone pain include:
- Pain management with NSAIDs
- Medical expulsive therapy with alpha-blockers
- Adequate fluid intake
- Warm compresses for comfort
- Monitoring for complications and prompt medical attention when necessary.
From the Research
Treatment Options for Kidney Stone Pain
- Non-steroid anti-inflammatory agents (NSAIDs) can be used to relieve pain, as stated in the study 2.
- Opioid analgesics are also an option, with the study 2 mentioning that they are the first-choice therapy during pregnancy.
- Alpha-blockers, such as tamsulosin, have been shown to be beneficial in increasing stone clearance rates, especially for ureteral stones ≤10 mm, as found in the study 3.
- The study 4 found that tamsulosin did not substantially improve outcome measures compared to treatment with ibuprofen and oxycodone alone in patients with distal ureteral calculi.
Medication Trends
- The use of opioids for kidney stone pain has decreased significantly from 2015 to 2021, as reported in the study 5.
- There was no significant trend in nonsteroidal anti-inflammatory drug (NSAID) use during the same period, according to the study 5.
- Regional variation and disparities in discharge prescriptions for Black and female patients were observed, highlighting opportunities for continued efforts, as noted in the study 5.
Alternative Pain Relief Options
- Intravenous ketamine has been compared to intravenous morphine in reducing pain of renal colic patients, with the study 6 finding that ketamine can produce a more rapid relief effect and decrease the use of opioids.
- The study 6 also found that ketamine had fewer side effects, such as nausea and vomiting, compared to morphine.