Toradol (Ketorolac) Should Be Avoided for Diverticulitis Pain
You should not give Toradol (ketorolac) for pain associated with diverticulitis, as non-aspirin NSAIDs are associated with a moderately increased risk of both incident diverticulitis episodes and complicated diverticulitis. 1
Recommended Pain Management Approach
First-Line Analgesic
- Acetaminophen is the primary analgesic for pain control in uncomplicated diverticulitis 2
- This recommendation prioritizes patient safety by avoiding medications that could worsen the underlying condition or trigger complications 2
Why NSAIDs Like Toradol Are Problematic
- The American Gastroenterological Association specifically advises patients with diverticulitis to avoid non-aspirin NSAIDs if possible (conditional recommendation, very-low quality evidence) 1
- Observational studies demonstrate that non-aspirin NSAIDs show a moderately increased risk of occurrence of any episode of diverticulitis AND complicated diverticulitis 1
- This risk is greater for non-aspirin NSAIDs than for aspirin, making ketorolac (Toradol) particularly concerning 1, 2
- Non-aspirin NSAIDs are selectively associated with diverticulitis progression, with an odds ratio of 3.2 (95% CI 1.5-6.9, p=0.002) 3
Alternative Pain Management Strategy
For Moderate to Severe Pain
- When acetaminophen is insufficient for severe pain, opioids are a more appropriate choice than NSAIDs in diverticulitis patients 4
- If opioids are necessary, manage the inevitable constipation proactively with naloxegol or osmotic laxatives like MiraLAX, as maintaining soft stools reduces intra-colonic pressure 4
Adjunctive Measures
- Clear liquid diet during the acute phase helps reduce pain by minimizing mechanical irritation of the inflamed colon 2
- Advance diet as symptoms improve, which naturally helps reduce pain 2
For Chronic Post-Diverticulitis Pain
- Approximately 45% of patients report periodic abdominal pain at 1-year follow-up, likely due to visceral hypersensitivity 2
- Low to modest doses of tricyclic antidepressants may be considered for persistent visceral hypersensitivity after the acute episode resolves 2
Important Caveat About Aspirin
- Unlike other NSAIDs, aspirin may be continued if indicated for cardiovascular protection, as the AGA suggests against routinely advising patients to avoid aspirin (the risk increase is slight: RR 1.25,95% CI 0.61-2.10) 1, 2
- The modest protective effects of aspirin on overall mortality and nonfatal myocardial infarction outweigh the slight diverticulitis risk in patients with cardiovascular indications 1