Analgesic and opioid use for patients discharged from the Emergency Department with ureteral stones.

OBJECTIVE To describe and characterize the analgesic and opioid use for patients discharged from the emergency department with renal colic due to ureteral stone. METHODS This is a secondary analysis of a multi-center prospective trial of emergency department patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone < 9 mm in diameter. Participants were contacted after randomization on days 2, 7, 15, 20 and 29 and reported opioid and non-opioid analgesic use and stone passage. CT scan was repeated on day 29-36 to confirm passage. RESULTS Out of 403 participants, 314 (77.9%) took any analgesic after discharge and 199 (49.4%) took opioids. Opioids were more commonly used in younger patients (p=0.04) and in those with a family history of stones (p=0.003). Stone size and tamsulosin use were not associated with analgesic utilization. Shorter time to passage and more distal stone location was associated with less analgesic and opioid use. For those that did not expel a stone, 55.0% took opioids at any time; and, for those that did expel a stone, 31.9% took opioids before the stone was expelled and 15.7% took opioids at any time after stone was expelled. CONCLUSIONS Factors associated with increased use of analgesics in patients discharged from the emergency department include a longer time to stone passage, no spontaneous passage and proximal position of the stone in the ureter. Some patients continue to use analgesics after stone has passed but most have stopped using by day 29. Study registered at https://clinicaltrials.gov (NCT00382265).