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Intramuscular piroxicam is better than Intramuscular diclofenac for renal colic

Three Part Question

[In renal colic] is [IM piroxicam or IM diclofenac] better [at reducing pain]?

Clinical Scenario

A 35 year old male presents to A&E with acute renal colic proven on urine dipstick analysis and urgent IVU. His pain is severe and you would like to give him IM diclofenac as he is vomiting and it is your current practice. He tells you he developed a sterile abscess last time he was given IM diclofenac. You wonder if an alternative NSAID, piroxicam, given by the IM route would be as effective as the diclofenac you are reluctant to give.

Search Strategy

Medline 1966-08/01 using the OVID interface.
[exp piroxicam OR OR] AND [exp diclofenac OR OR] AND [exp kidney calculi OR exp Ureteral calculi OR renal]

Search Outcome

2 papers were identified of which 1 was relevant.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Al-Waili NS and Saloom KY,
64 patients with proven diagnosis of renal colic on IVU, USS and clinical examination Those taking NSAIDS or pethidine on long-term basis excludedDouble blind randomised controlled studyChange in mean pain scores at 30 and 60 minutes post administration of 75mg IM diclofenac or 40mg IM piroxicam as measured on a Visual Analogue 10cm lineBoth treatments dramatically decreased pain scores by 30 minutes. Diclofenac pre-treatment score 7.83 and 30 minutes post treatment 1.47; piroxicam pre-treatment score 7.41 with 30 minutes post treatment score 0.84. There was a significant improvement in favour of piroxicam for pain relief at 30 minutes (t-test of means p<0.05)The blinding mechanism is not given Uncertain of sampling method


Both forms of IM NSAID work well with some small advantage in favour of piroxicam in terms of pain relief at 30 minutes. IM voltarol has several notable administration problems that piroxicam does not.

Clinical Bottom Line

IM piroxicam appears to perform better than IM diclofenac for renal colic pain relief. Given it has fewer injection site side effects IM piroxicam should replace IM diclofenac for renal colic.


  1. Al-Waili NS and Saloom KY. Intramuscular piroxicam versus intramuscular diclofenac sodium in the treatment of acute renal colic: double-blind study. European Journal of Medical Research 1999;4(1):23-6.