Evidence-Based Medicine
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2016; 8(10): 713-718
Published online Oct 27, 2016. doi: 10.4240/wjgs.v8.i10.713
Acute pain management in symptomatic cholelithiasis
Tahir Masudi, Helen Capitelli-McMahon, Suhail Anwar
Tahir Masudi, Helen Capitelli-McMahon, Suhail Anwar, York Hospitals NHS Foundation Trust, the York Teaching Hospital, North Yorkshire YO31 8HE, United Kingdom
Author contributions: All authors contributed to this paper.
Conflict-of-interest statement: There are no conflicts of interest arising from this work.
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Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tahir Masudi, FEBS, MRCS, York Hospitals NHS Foundation Trust, the York Teaching Hospital, Wigginton Road, York, North Yorkshire YO31 8HE, United Kingdom. tahir.masudi@yahoo.com
Telephone: +44-7950-794197
Received: May 21, 2016
Peer-review started: May 23, 2016
First decision: July 4, 2016
Revised: August 20, 2016
Accepted: September 7, 2016
Article in press: September 8, 2016
Published online: October 27, 2016

To review the evidence for the use of different non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of biliary colic.


The strategies employed included an extensive literature review for articles and studies related to biliary colic from electronic databases including PubMed, Science Direct, Wiley Inter Science, Medline and Cochrane from last 15 years. Keywords: “Biliary colic”, “management of biliary colic”, “non-steroidal anti-inflammatory drugs”, “cholelithiasis” and “biliary colic management”. Six randomized control trials, 1 non-randomized trial and 1 meta-analysis were included in this review. The outcomes of these studies and their significance have been reviewed in this paper.


Current evidence suggests there are no set protocols for biliary colic pain management. NSAIDs are potent in the management of biliary colic, not only in terms of symptom control but in disease progression as well. Apart from the studies on diclofenac and ketorolac, there are studies which have shown that intravenous tenoxicam and injectable flurbiprofen are equally effective in managing biliary colic. The efficacy of NSAIDs is superior in terms of lower number of doses and longer duration of action in comparison to other analgesic agents.


This literature review has found that NSAIDs are safe and effective for pain control in biliary colic, and reduce the likelihood of further complications.

Keywords: Biliary colic, Management of biliary colic, Non-steroidal anti-inflammatory drugs, Cholelithiasis, Biliary colic management

Core tip: There are currently no set protocols for pain management in biliary colic. This literature review analyses studies from the last 15 years and shows that non-steroidal anti-inflammatory drugs (NSAIDs) provide safe and effective pain control. It also suggests that NSAIDs play an important role in reducing the complication risk following episodes of biliary colic.