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

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.