Pain control in Extracorporeal Shock Wave Lithotripsy (ESWL): A narrative review based on pharmacological and non-pharmacological methods

Abstract

Background: Some cases of urinary lithiasis could be managed by a relatively none invasive procedure of ESWL; while it could be painful experience. This study aimed at systematically reviewing the different management methods of the pain during the ESWL.
Methods: In this narrative review, online databases were quarried for studies reporting pharmacological and non-pharmacological methods of the pain management during the ESWL.
Results: Fifty-two articles were included in this study. In this article, pharmacological and non-pharmacological methods of pain control in ESWL were investigated. The drugs under review include: Tramadol, Acetaminophen/Paracetamol, Fentanyl, Pethidine, Remifentanil, Morphine, Pentazocine, Dexmedetumidine, Diclofenac sodium, Ketorolac, Pregabalin, Lornoxicam, Parecoxib sodium, Melatonin, Inhalation gases (Entonex gas), and different gels of Piroxicam gel, Lidocaine gel, and EMLA. and non-pharmacological methods include: Prayer therapy, Sterile water, Acupuncture, TENS and Music therapy.
Conclusion: for pain management during the ESWL multiple options of both pharmacological and non-pharmacological interventions are available that are supported by high level evidences in RCTs. Physicians should select the options based on the condition of the patient to prevent the potential adverse events.