to the editor: Drs. Frassetto and Kohlstadt provide a useful summary of kidney stone management. However, their discussion of pain control is limited to opioid analgesics and suggests avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) because of their effects on renal blood flow and glomerular filtration rate. Although there are patients in whom NSAIDs should be used with caution or avoided (e.g., patients with chronic kidney disease), there is inadequate evidence demonstrating significant harms from NSAIDs in patients with renal colic.

A Cochrane review concluded that both NSAIDs and opioids provide effective relief from renal colic. Some evidence suggested that NSAIDs were more effective, and that opioid use was associated with more adverse effects, mainly vomiting.¹ Trials included in this Cochrane review did not directly assess gastrointestinal bleeding or worsening of renal function. However, these potential adverse effects were infrequent in the Cochrane review and in a previously published meta-analysis of NSAIDs for renal colic.²

Treatment harms are important, and trials designed to show if NSAIDs pose a risk in kidney stone treatment would be helpful. However, based on a paucity of evidence that NSAIDs are harmful in most patients with kidney stones, physicians should not exclude NSAIDs as an option for relieving renal colic.