From the Guidelines
For kidney stone pain treatment, start with over-the-counter pain relievers like ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours or naproxen (Aleve) at 220-440mg every 8-12 hours, as recommended by recent guidelines 1.
Key Considerations
- For more severe pain, prescription medications such as ketorolac (10mg orally every 4-6 hours) or narcotic pain relievers like oxycodone may be necessary.
- Drink plenty of fluids, aiming for 2-3 liters of water daily to help flush out the stone, as increased fluid intake is associated with a reduction in stone recurrence 1.
- Alpha-blockers like tamsulosin (Flomax) at 0.4mg daily can relax ureter muscles, making stone passage easier and less painful.
- Apply heat to the painful area using a heating pad or warm bath for additional relief.
- Medical attention is essential for severe pain, fever, vomiting, or inability to urinate.
Stone Passage and Prevention
- Most kidney stones under 5mm will pass naturally within 1-2 weeks.
- Pain occurs because stones stretch the ureter as they move, triggering nerve endings and causing intense discomfort.
- The combination of pain control, increased fluid intake, and medications to relax the urinary tract provides the most effective approach to managing kidney stone pain while facilitating stone passage.
Evidence-Based Recommendations
- The American College of Physicians (ACP) recommends management with increased fluid intake spread throughout the day to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis, based on low-quality evidence 1.
- ACP also recommends 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, based on moderate-quality evidence 1.
From the Research
Kidney Stone Pain Treatment Options
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as the preferred analgesia for renal colic, as they offer effective and sustained pain relief with fewer side effects compared to opioids or paracetamol 2
- NSAIDs have been shown to require fewer rescue treatments and have lower vomiting rates compared to opioids 2
- Alpha-blockers have been demonstrated to increase expulsion rates of distal ureteral stones, decrease time to expulsion, and decrease need for analgesia during stone passage 3
- In pediatric patients, alpha blockers have been shown to be effective in reducing stone expulsion time, increasing stone passage rate, and decreasing pain episodes and analgesic requirements 4
Treatment Approaches
- The first priority in treating renal colic is to rule out conditions requiring immediate referral to an emergency department, then to alleviate pain, preferably with a nonsteroidal anti-inflammatory drug 5
- Conservative management consists of pain control, medical expulsive therapy with an alpha blocker, and follow-up imaging within 14 days to monitor stone position and assess for hydronephrosis 5
- Asymptomatic kidney stones should be followed with serial imaging, and should be removed in case of growth, symptoms, urinary obstruction, recurrent infections, or lack of access to health care 5
Prevention and Management
- Lifestyle modifications such as increased fluid intake should be recommended for all patients, and thiazide diuretics, allopurinol, or citrates should be prescribed for patients with recurrent calcium stones 5
- Patients at high risk of stone recurrence should be referred for additional metabolic assessment, which can serve as a basis for tailored preventive measures 5
- Medical treatment of nephrolithiasis is aimed at preventing relapses, and includes water intake, diet, and drugs, with the goal of dissolving calculi or preventing their formation 6