A recent study published in the Academic Emergency Medicine revealed that common pain relievers, piroxicam and paracetamol, do not significantly reduce pain recurrence or prevent emergency department (ED) readmissions in patients treated for renal colic (RC). The study assessed the efficacy and safety of these medications in managing pain after patients were discharged from the ED.
This prospective, randomized, single-blind trial was conducted across four emergency departments. A total of 1,383 adults with RC were included in the study and were randomly assigned to receive either piroxicam, paracetamol, or a placebo for 5 days following their discharge from the ED. The primary focus was to determine if these medications could prevent pain recurrence and reduce the likelihood of patients returning to the ED within 7 days. Secondary outcomes included the time to pain recurrence and any side effects associated with the treatments.

The results indicated no significant differences in the efficacy of piroxicam or paracetamol when compared to the placebo in preventing pain recurrence. Pain recurrence within 7 days was observed in 29% of patients in the piroxicam group, 30.3% in the paracetamol group, and 30.8% in the placebo group. These figures suggest that the use of either piroxicam or paracetamol does not provide any substantial advantage in managing post-ED discharge pain for RC patients.
Further analysis showed that most patients who underwent pain recurrence did so within the first 2 days after discharge. Also, 86% of patients in both the piroxicam and placebo groups, and 84.1% in the paracetamol group, reported pain recurrence within this period. These findings highlight the early and acute nature of pain recurrence in RC patients, regardless of the treatment given. Emergency department readmission rates were similarly unaffected by the choice of medication. The study reported readmission rates of 20.8% for the piroxicam group, 23.8% for the paracetamol group, and 22.9% for the placebo group, with no statistically significant differences between the groups.
An important aspect of the study was the assessment of treatment-related side effects. The piroxicam group reported a significantly higher incidence of adverse effects when compared to the other groups. This finding raises concerns about the safety profile of piroxicam, especially given its lack of efficacy in preventing pain recurrence. Overall, the study suggests that neither piroxicam nor paracetamol is effective in preventing pain recurrence or reducing ED readmissions in RC patients.
Source:
Jaballah, R., Toumia, M., Youssef, R., Ali, K. B. H., Bakir, A., Sassi, S., Yaakoubi, H., Kouraichi, C., Dhaoui, R., Sekma, A., Zorgati, A., Beltaief, K., Mezgar, Z., Khrouf, M., Bouida, W., Grissa, M. H., Saad, J., Boubaker, H., Boukef, R., … Nouira, S. (2024). Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo‐controlled trial. In Academic Emergency Medicine. Wiley. https://doi.org/10.1111/acem.14996