NSAIDS better than opioids for renal colic

Patients with renal colic get better pain relief and are less likely to need other analgesia if they are given non-steroidal anti-inflammatory drugs (NSAIDs) rather than opioids, Australian researchers report in the British Medical Journal.Renal colic, which typically involves the sudden onset of severe pain radiating from the flank to the groin, is often caused by the passage of calculi through the urinary tract. Anna Holdgate and Tamara Pollock from St George Hospital, Kogarah, conducted a systematic review of studies using the Cochrane Renal Group's specialised register, the Cochrane central register of controlled trials, Medline, Embase, and reference lists of retrieved articles.They studied randomised controlled trials that compared any opioid with any NSAID in acute renal colic, as long as they reported any of the following outcomes: patient rated pain, time to pain relief, need for rescue analgesia, rate of recurrence of pain, and adverse events.The researchers found 20 trials with a total of 1613 participants. Both groups of drugs had clinically important effects on patient reported pain scores, but a pooled analysis of six trials showed a greater reduction in pain scores for patients treated with NSAIDs than with opioids. Patients who were given NSAIDs were also significantly less likely to require rescue analgesia (relative risk 0.75, 95% confidence interval 0.61 to 0.93). "Most trials showed a higher incidence of adverse events in patients treated with opioids," the authors write. "Compared with patients treated with opioids, those treated with NSAIDs had significantly less vomiting (0.35, 0.23 to 0.53). Pethidine was associated with a higher rate of vomiting."The findings that NSAIDS provided slightly better analgesia with fewer side effects are in keeping with other studies, the researchers note. "Although the finding of improved analgesia in patients with renal colic may relate to the local synthesis and release of prostaglandins specific to this condition," they suggest.Reference...