Quality statement 2: Pain management
Pain relief is the first step in managing acute renal colic. NSAIDs are the most effective form of pain relief for renal colic. Ensuring that people receive NSAIDs by any route as first-line treatment, unless there are contraindications, reduces the need for additional pain relief and reduces ongoing pain.
Evidence of written clinical protocols to ensure that people with suspected renal colic are offered an NSAID as first-line treatment, unless it is contraindicated.
Data source: Local data collection, for example, service protocols.
Proportion of adults, children and young people newly presenting with suspected renal colic, and no contraindications for an NSAID, who receive an NSAID as first-line treatment.
Numerator – the number in the denominator who receive an NSAID as first-line treatment.
Denominator – the number of adults, children and young people newly presenting with suspected renal colic and no contraindications for an NSAID.
Data source: Local data collection, for example, local audit of patient records.
Service providers (such as GP practices and emergency departments) ensure that written clinical protocols are in place to offer an NSAID by any route as first-line treatment for adults, children and young people with suspected renal colic, unless it is contraindicated.
Healthcare professionals (such as GPs and emergency department practitioners) take a medical history and carry out a clinical examination of adults, children and young people presenting with acute abdominal or flank pain. If renal colic is suspected, they offer an NSAID by any route as first-line treatment, unless it is contraindicated.
Commissioners (such as clinical commissioning groups and NHS England) ensure that services have written clinical protocols in place for offering an NSAID by any route as first-line treatment for adults, children and young people with suspected renal colic, unless it is contraindicated.
Adults, children and young people with severe pain that could be kidney stones have an examination of their abdomen and discuss their symptoms with a healthcare professional. They discuss pain relief and treatment options and, if the doctor thinks they might have a kidney stone, they are offered a non-steroidal anti-inflammatory drug (NSAID) to help with the pain, unless there is a reason why it is unsuitable.
Renal and ureteric stones: assessment and management. NICE guideline NG118 (2019), recommendation 1.2.1
Suspicion based on history and clinical examination of people presenting with abdominal or flank pain in general. [NICE's guideline on renal and ureteric stones, evidence review B]
People with dementia, cognitive impairment, learning disabilities or language barriers may have difficulties communicating their pain threshold. Healthcare professionals should establish the person's cognitive status, and whether they have any speech, language or other communication needs. They should also establish the person's current level of understanding; and whether they would like a person important to them to be present when discussing their pain and pain relief.
NSAIDs should be avoided during pregnancy, and particularly in the third trimester, unless the potential benefit outweighs the risk. If their use cannot be avoided in the third trimester, the UK Teratology Information Service recommends that antenatal monitoring is discussed with a fetal medicine unit. Healthcare professionals should offer alternative pain management for suspected renal colic during pregnancy in line with the recommendations on pain management in NICE's guideline on renal and ureteric stones.