From the Research
For pain management in a patient with a 3 mm kidney stone at the ureterovesical junction (UVJ) who is allergic to hydrocodone, I recommend starting with ketorolac (Toradol) 30 mg IV or 10 mg orally every 6 hours for acute pain relief, as it is a non-opioid alternative that can effectively reduce ureteral pressure and inflammation, and its use is supported by recent studies on pain management in patients with kidney stones 1. This can be combined with acetaminophen (Tylenol) 1000 mg every 6 hours. If additional pain control is needed, consider tramadol 50-100 mg every 6 hours if there's no cross-sensitivity with the hydrocodone allergy, or a non-opioid alternative such as celecoxib 200 mg twice daily. The patient should maintain high fluid intake of 2-3 liters daily to help pass the stone. The mild left hydroureteronephrosis and bladder wall thickening suggest both obstruction from the stone and possible infection. If fever, worsening pain, or signs of infection develop, immediate medical attention is needed as this could indicate an obstructive pyelonephritis requiring antibiotics and possibly urgent intervention. NSAIDs like ketorolac work well for renal colic by reducing ureteral pressure and inflammation, while acetaminophen provides complementary pain relief through different mechanisms. The 3 mm stone has a good chance of passing spontaneously, but follow-up imaging should be arranged to confirm passage. The patient should strain their urine to catch the stone for analysis to guide prevention strategies. It's also important to note that opioid allergy labels are often unsubstantiated in clinical practice, and the removal of erroneous opioid allergy labels has a unique importance in the population with acute or chronic pain, as discussed in a review on opioid allergy labels 2. Additionally, a study on opioid metabolism and drug-drug interactions highlights the importance of considering these interactions when prescribing opioids, although this may not be directly relevant to the current patient's situation given the hydrocodone allergy 3.