How should I manage pain in a patient with acute renal colic in primar

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Pain management in acute renal colic in primary care should follow a stepwise approach:

Offer a nonsteroidal anti-inflammatory drug (NSAID) by any route as first-line treatment for pain relief.
If NSAIDs are contraindicated, not tolerated, or insufficient for pain control, offer intravenous (IV) paracetamol if available.
If both NSAIDs and IV paracetamol are contraindicated, ineffective, or IV paracetamol is unavailable, consider an opioid analgesic such as tramadol.
Do not offer antispasmodics as they provide no benefit and carry risks.
Provide written information about renal and ureteric stones to the patient.

This approach applies to adults, children, and young people presenting with suspected renal or ureteric colic.

How should I manage pain in a patient with acute renal colic in primary care?