No Renal Colic Recurrence With Piroxicam and Paracetamol?

TOPLINE:

Piroxicam and paracetamol do not prevent pain recurrence or emergency department (ED) readmission within 7 days of renal colic treatment. The incidence of adverse effects is higher in patients administered piroxicam.

METHODOLOGY:

• A prospective, randomized, single-blind, placebo-controlled trial was conducted in four EDs in Tunisia over 5 years.
• A total of 1383 adult patients with renal colic were randomly assigned to receive either piroxicam (20 mg daily; n = 462; mean age, 42.9 years), paracetamol (2 g daily; n = 462; mean age, 43.6 years), or placebo (n = 459; mean age, 43.5 years) for 5 days after ED discharge.
• The primary outcomes were pain recurrence and the rate of ED readmission within 7 days of treatment, and the secondary outcomes were the mean time to pain recurrence and the occurrence of treatment-related side effects.
• No additional treatments were provided, and patients were instructed to avoid the use of over-the-counter analgesics during the study period.
• Pain assessment was conducted using a numeric rating scale by trained clinical research associates.

TAKEAWAY:

• The rate of pain recurrence within a week was 29% for the piroxicam group, 30.3% for the paracetamol group, and 30.8% for the placebo group, with no significant differences observed between the groups.
• The rates of ED readmission were comparable across the groups: 20.8% for the piroxicam group, 23.8% for the paracetamol group, and 22.9% for the placebo group (P =.52).
• Among the patients who experienced pain recurrence, the majority encountered it within 2 days of discharge from the ED.
• The incidence of adverse effects, including epigastric pain and vomiting, was significantly higher in the piroxicam group than in the other groups; however, no serious adverse effects were observed.

IN PRACTICE:

“Piroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC [renal colic] treatment,” the authors wrote. “The piroxicam group reported significantly higher adverse effects compared to others,” they added.

SOURCE:

The study was led by Rahma Jaballah, MD, Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia, and Emergency Department, Sahloul University Hospital, Sousse, Tunisia. It was published online on August 19, 2024, in Academic Emergency Medicine.

LIMITATIONS:

The choice of piroxicam may have influenced the interpretation of the results, as other nonsteroidal anti-inflammatory drugs may yield different outcomes. Diagnostic imaging was not performed for all patients, which resulted in a lack of data on the number, location, and size of urinary stones. Moreover, the spontaneous use of rescue analgesia by some patients may have affected the primary endpoint. Data on specific adherence metrics were not collected in this study, which could have impacted the interpretation of the results.

DISCLOSURES:

No funding information was provided for the study. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.