Pain relief is the most important factor in stone treatment management and there has been a trend toward the use of non-steroidal anti-inflammatory agents (NSAID) as first line agents. This could be because of the concern towards opiate seeking patient.

Evidence suggests opiates and NSAID’s are equally effective at controlling pain (ureteric colic) and are often used in combination. There is concern that opiates may lead to an increase in ureteric tone but conversely NSAID may interfere with the kidney’s ability to auto regulate its response to obstruction leading to a reduction in renal blood flow.

NSAIDs are contraindicated in patients with pre-existing renal impairment and care should be taken in those with asthma and pre-existing gastrointestinal disorders. The role of other agents such as desmopressin and acupuncture is uncertain.