Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our 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
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
NSAIDs versus placebo | ||
Pain (visual analog 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
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- Is there randomized controlled trial evidence to support the use of nonsteroidal anti-inflammatory drugs (NSAIDS) compare with other analgesics and each other in people with acute renal colic?
- What are the effects of alpha‐blockers as medical expulsive therapy for people with ureteral stones?
- For adults undergoing ureteroscopy for ureteral calculi clearance, how does placement of a ureteral stent affect outcomes?
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