Nonintravenous Therapy for Acute Renal Colic Pain

Summary and Comment |
July 14, 2014

Nonintravenous Therapy for Acute Renal Colic Pain

  1. Daniel J. Pallin, MD, MPH

The analgesic effect of sublingual buprenorphine was comparable to that of intravenous morphine.

  1. Daniel J. Pallin, MD, MPH

Emergency clinicians commonly administer intravenous opioids to relieve pain in renal colic patients. But would a sublingual analgesic be as effective? To find out, investigators in Iran conducted a double-blind, double-dummy, placebo-controlled, randomized trial of sublingual buprenorphine (2 mg), versus intravenous morphine (0.1 mg/kg) in 69 patients with acute renal colic.

Pain relief at 20 and 40 minutes after treatment and the need for rescue analgesia were similar with buprenorphine or morphine; dizziness was more common with buprenorphine (62% vs. 38%).


Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment of renal colic, but opioids are useful for rapid pain relief in the initial phase and for breakthrough pain with NSAID use. Intravenous opioids are often used because of their rapid effect and ease of titration. This study demonstrates that opioids may be given sublingually. Because there is no proven value to administration of intravenous fluids, such an approach facilitates prompt, effective treatment of renal colic without the need for an intravenous line.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / Research support NIH Leadership positions in professional societies Society for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee)


Reader Comments (1)

RICK ABBOTT Physician, Emergency Medicine

Neither of the tested regimens worked very well. If you use suboptimal opioid dosing, that both give suboptimal symptom control, they will look equivalently bad. When is the last time that you got good pain relief in a ureteral colic patient with 0.1 mg/kg of morphine?

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