Evidence

Evidence tables

This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.


Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.


Population: People with symptomatic renal or ureteric stones

Intervention: NSAIDs ᵃ

Comparison: Opioid or acetominophen or antispasmodic or placebo

OutcomeEffectiveness (BMJ rating)?Confidence in evidence (GRADE)?

NSAIDs versus placebo

Pain (visual analogue scale [VAS]; 0-10), change & final scores: follow-up 25 minutes to 10 days; range of scores: 0-10

Favors intervention

Very Low

Pain relief (VAS; 0-10): follow-up 180 minutes; range of scores: 0-10

Favors intervention

Moderate

Need for rescue medication: follow-up 25 minutes

Favors intervention

Low

No pain relief: follow-up 25 minutes

Favors intervention

Moderate

Pain relief, partial or complete: follow-up 25-30 minutes

No statistically significant difference

Very Low

NSAIDs versus paracetamol

Pain (numerical rating scale [NRS] or VAS): follow-up 30 minutes; range of scores: 0-10

No statistically significant difference

Very Low

Reduction in pain by 50% or in NRS pain score >3: follow up 30 minutes

No statistically significant difference

High

Persistent pain: follow-up 60 minutes

Favors intervention

Moderate

Pain relief ᵇ

No statistically significant difference

Low or Very Low ᵇ

Need for rescue medication: follow-up 30 minutes

Favors intervention

Moderate

Minor adverse events (unspecified, vomiting, abdominal pain, dizziness, epigastric pain) ᶜ

No statistically significant difference

Very Low

NSAIDs versus opioids

Pain (VAS & NRS), final and change scores: at 30-60 minutes; range of scores: 0-10

No statistically significant difference

Very Low

Pain (VAS) (at 30 minutes; range of scores: 1-10) or need for rescue medication (at 30-40 minutes)

Favors intervention

Very Low

Pain relief (no pain relief, partial pain relief, or complete pain relief): up to 60 minutes follow-up/at discharge

No statistically significant difference

Very Low

Persistent pain: at 60 minutes

Favors intervention

High

Reduction in pain NRS score >3 at 30 minutes

No statistically significant difference

High

Reduction in pain by 50% at 30 minutes

No statistically significant difference

Very Low

Major adverse events (significant side effects): follow-up not reported

No statistically significant difference

Low

Minor adverse events ᵈ

Occurs more commonly with opioids compared with NSAIDs (favors intervention)

Moderate to Very Low ᵈ

Minor adverse events (urinary retention) at 60 minutes

No statistically significant difference

Very Low

Minor adverse events (pain at injection site) at 12 hours

Occurs more commonly with intramuscular NSAIDs compared with intramuscular opioids (favors comparison)

Low

NSAIDs versus antispasmodics

Pain (VAS, 0-10): follow-up 40 minutes; range of scores: 0-10

No statistically significant difference

Low

Complete pain relief: follow-up 30 minutes

Favors intervention

Low

Need for rescue medication: follow-up 40-60 minutes

No statistically significant difference

Very Low

Minor adverse events (sleepiness)

Occurs more commonly with antispasmodics compared with NSAIDs (favors intervention)

Moderate

Minor adverse events (dizziness)

No statistically significant difference

Low

Recommendations as stated in the source guideline

Offer an NSAID by any route as first-line treatment for adults, children, and young people with suspected renal colic.

Note

ᵃ Most of the studies evaluated an intravenous or intramuscular route of administration, with just one study using an oral preparation and four studies using a rectal preparation. The guideline committee acknowledged that the latter two are more commonly used and that the results may not reflect practice in the UK; however, they also noted that the evidence was not sufficient to include any one route of administration in the recommendation.

ᵇ The outcome of partial pain relief at discharge was graded as low-quality evidence while complete pain relief at discharge/unclear time point was graded as very low-quality evidence. Three randomized controlled trials underpinned these outcomes (one for partial pain relief and two for complete pain relief), showing no statistically significant difference between treatment groups.

ᶜ Follow-up times range from 60 minutes to 14 days for unspecified and vomiting outcomes, but are not reported for abdominal pain, dizziness, and epigastric pain.

ᵈ Minor adverse events include: unspecified at 14 days; nausea and vomiting at 30 minutes to 24 hours; vomiting, nausea, dizziness with unclear time point or not reported; and sleepiness at 1-24 hours or not reported. The evidence underpinning these outcomes ranged from moderate to very low quality.

This evidence table is related to the following section/s:

Cochrane Clinical Answers

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