BMJ 2004;328:1401 (12 June)
Systematic review of the relative efficacy of non-steroidal
anti-inflammatory drugs and opioids in the treatment of acute
Objective To examine the relative benefits and disadvantages
of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids
for the management of acute renal colic.
Data sources Cochrane Renal Group's specialised register, Cochrane
central register of controlled trials, Medline, Embase, and
reference lists of retrieved articles.
Review methods Randomised controlled trials comparing any opioid
with any NSAID in acute renal colic if 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
Results 20 trials totalling 1613 participants were identified.
Both NSAIDs and opioids led to clinically important reductions
in patient reported pain scores. Pooled analysis of six trials
showed a greater reduction in pain scores for patients treated
with NSAIDs than with opioids. Patients treated with NSAIDs
were 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. 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.
Conclusions Patients receiving NSAIDs achieve greater reductions
in pain scores and are less likely to require further analgesia
in the short term than those receiving opioids. Opioids, particularly
pethidine, are associated with a higher rate of vomiting.