What causes body cramps from renal (kidney) colic?

From the Guidelines

Body cramps from renal colic are primarily caused by intense muscle spasms as the ureter contracts to move a kidney stone, and the most effective treatment is analgesia, specifically diclofenac given by intramuscular injection, to provide rapid pain relief within half an hour. When considering the management of acute renal colic, it's crucial to prioritize treatments that address both the pain and the underlying cause, such as the movement of the kidney stone. According to the consensus reached in the study published in the BMJ 1, the use of diclofenac for analgesia is highly recommended due to its effectiveness in providing rapid pain relief. Some key aspects of care for renal colic include:

• Establishing a diagnosis based on abrupt onset of severe unilateral flank pain radiating into the groin or genitals, as noted in the study 1.
• Considering atypical cases, such as a leaking abdominal aortic aneurysm in patients over 60 years of age, or ectopic pregnancy in women with delayed menses, as suggested by the consensus group 1.
• The assessment of pain, although a visual analogue scale can be helpful, many general practitioners prefer to judge severity themselves, as indicated in the study 1.
• The importance of urinalysis for blood on site, with general agreement that haematuria supports the diagnosis, despite some practical considerations, as discussed in the study 1.
• Examination must include assessment of the abdomen and exclusion of signs consistent with other conditions, along with assessment of vital signs to exclude signs of shock and systemic infection, as recommended by the consensus group 1.
• Treatment should focus on providing rapid pain relief, with diclofenac given by intramuscular injection being the preferred option, as stated in the study 1.
• Failure of analgesia after 1 hour should prompt immediate admission to hospital, as advised by the consensus group 1.
• Maintaining higher fluid intake and attempting to sieve urine are also recommended for patients with suspected acute renal colic, as suggested in the study 1.
• Fast track investigation, including renal imaging within 7 days of onset and urology outpatients within 14 days of onset, is also favored, as noted in the study 1. Given the emphasis on rapid pain relief and the effectiveness of diclofenac, as supported by the highest quality and most recent evidence available 1, the use of diclofenac given by intramuscular injection is the most strongly recommended treatment for body cramps from renal colic.

From the Research

Causes of Body Cramps from Renal Colic

• Renal colic is acute pain caused by urinary stones, with a prevalence of 10% to 15% in the United States 2
• The pain is usually severe and caused by hyperperistalsis of the obstructed ureter, modulated by alpha-receptors, beta-receptors, and prostaglandins 3
• Non-steroidal anti-inflammatory drugs (NSAIDs) are highly effective in pain relief and should always be given in the absence of contraindications 2, 4, 5, 3

Mechanism of Pain Relief

• NSAIDs reduce pain by inhibiting prostaglandin synthesis, which is involved in the modulation of peristalsis in the obstructed ureter 5
• Combination therapy of NSAIDs plus antispasmodics is not significantly more effective in pain control than NSAID alone 2
• Opioids, such as morphine, are also effective in pain relief, but may have more adverse effects than NSAIDs 4, 6

Treatment Options

• NSAIDs, such as diclofenac, are commonly used for pain relief in renal colic 2, 4, 5
• Opioids, such as morphine, may be used when NSAIDs are contraindicated or ineffective 4, 6
• Alpha-blockers and calcium channel blockers may also be used to dilate the distal ureter and increase the likelihood of spontaneous stone passage 6, 3