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By Paul M. Dake, M.D.

Q:  My 26-year-old son recently had to go to the Emergency Department because of severe pain in his side that came on quite abruptly; he was told he had a kidney stone that should pass within 10-12 hours, and was sent home with only a prescription for naproxen for pain.  I had the same problem when I was about his age and was given an antibiotic and some strong pain medication. Why the change in treatment from then until now?

A:  Twenty or thirty years ago, it was felt that everyone with a kidney stone must have an abrasion-type injury to the inside of the ureter, the tube that carries urine from the kidney down to the bladder, and the antibiotic was needed to prevent any infection from starting before the abrasion had a chance to heal.

It has since been shown that the lining of the ureter is the same type of tissue that lines the entire mouth, and that bite injuries in the mouth to the tongue or cheeks, where the exposure to many types of bacteria is much more intense than inside the ureter, still heal rapidly without antibiotics.  Trials in which antibiotics are not given for mouth injuries have shown the same rapid healing; the conclusion was that with no exposure to bacteria in the ureter, antibiotics would certainly be unnecessary.

Also, a large proportion of individuals given strong (narcotic) pain medications, for any problem, are much more likely to become severely constipated, making the pain from the kidney stone seem mild in comparison.

Naproxen is one of the Non-Steroidal Anti-Inflammatory Drugs (NSAID) and, taken twice daily with food along with two tablets of acetaminophen 500 mg (generic form of Extra Strength Tylenol), has been shown to work just as well for kidney stone pain without the constipating side effects.

To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website familydoctor.org, where you can click on the Search box in the upper right corner of the website, and enter your topic of interest.

I want to thank Ron G. for suggesting this topic; if you have any particular topic you would like to hear more about, please message me at paulmdake@gmail.com.