Low-Dose Morphine Less Effective Than Diclofenac or Acetaminophen for Renal Colic


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Am Fam Physician. 2016 Oct 15;94(8):665.

Clinical Question

Which analgesics are most effective in providing significant pain relief in patients who are passing kidney stones in the emergency department?

Bottom Line

This is a good example of how a well-done study can lead to erroneous conclusions. The comparator most likely to be effective here—titrated morphine—was used at a low dose and found to be less effective than intramuscular diclofenac or intravenous paracetamol (acetaminophen). (Level of Evidence = 1b)


These authors randomly assigned more than 1,600 patients who presented to an emergency department with suspected kidney stones and pain severity of at least 4 out of 10 to receive 75 mg of intramuscular diclofenac (n = 548), 1 g of intravenous paracetamol (n = 548), or 0.1 mg per kg of intravenous morphine (n =

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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