Kidney stone pain management

July 9, 2022 1:43 PM

You are not my doctor. I have a doctor but she is out until august. Help me safely manage my kidney stone pain just over this weekend.

I was in the ER yesterday after a few days of excruciating flank pain. Anyway long story short: I have a 5mm kidney stone in my ureter right now. It runs in my family. (Dad says his are the calcium type.) I’m female, 37, diagnosed anxiety disorder and high blood pressure, overweight, short. I had an ultrasound and a CT, blood and urine test, blah blah. Everything other than my kidney looked totally unremarkable, which is good. I am not feverish and only have a little microscopic blood in my urine.

They gave me lovely meds through the iv while I was there, toradol I think? I could sit comfortably for the first time in a day. Left the er with an rx for flomax, naproxen 500mg, a 4-times daily antibiotic for five days, and 12 doses of hydrocodone-acetemin 5-325 mg.

I also have daily meds I take for my anxiety and bp. 100mg sertraline and 25mg atenolol, a beta blocker. And, I’ve been taking an otc Zyrtec for my pollen allergy this summer.

What happened last night was this: the meds from the er wore off so I took a naproxen a bit early. By midnight my flank pain was interfering with my ability to lie still and try to sleep and I hadn’t slept well in nearly two days. So I took one hydrocodone. Within ten minutes I was shaking and shivering uncontrollably, sweaty and clammy, stomach cramps. Over the next two hours my housemate kept watch over me as I shook and had classic awful diarrhea and he warmed me up with hugs and blankets. My breathing was a bit panicky at first but always able to get a breath, my pulse was fast but not irregular. I wasn’t confused, just upset. After some time on the toilet I felt better and wasn’t shivering. Took about two hours but I was fine and my pain was mitigated somewhat still. I went back to my own bed and slept well enough. Conclusion? Mild to moderate serotonin syndrome from the opioid, though i am not a doctor.

The practice with my PCP is closed on the weekends. I don’t have contact info for the doctor who diagnosed me in the er, but I do have his name on my tests displayed on MyChart (no way to send him a message on that though). I have a referral to the urology department at the hospital I went to but no appointment yet. My current plan is to hold out till Monday, call my normal practice and see what they say and maybe have a virtual visit to rx some other stronger pain meds for when the naproxen doesn’t cut it. But that leaves today and tomorrow.

I promise I will not be taking the hydrocodone (ever) again. The naproxen I took this morning is helping my pain but it’s definitely not fully effective and I’m sure it will wear off before my next dose at 8pm.

So, you are not my doctor, but can I take regular OTC Tylenol in combination with naproxen to help mitigate things for the next couple days? Or any other OTC pain meds? I am of course drinking absolutely as much water as I possibly can, trying to stay active, eating a healthy diet, not drinking my usual oolong tea (goodbye… I loved you…) and I promise I will contact doctors as soon as I can on Monday. I have health insurance and am in Seattle, USA.

Thank you for reading my huge chunk of text. I have named my kidney stone Barbarella.

posted by Mizu to Health & Fitness (8 answers total)

Best answer: Naproxen is a NSAID, so don't mix it with other painkillers like aspirin or ibuprofen that have a similar mode of action. Using naproxen and paracetamol together is safe as long as you stick to the recommended doses for each, and in fact they're somewhat synergistic.
posted by flabdablet at 1:56 PM on July 9, 2022

Just anecdotally, hydrocodone destroys me in ways similar to what you describe unless I take it with quite a bit of food. Like, not a bite or two, but a meal. And then it does its job without the symptoms you describe. (I'm a kidney stone person so I'm very sorry you're going through this.)
posted by BlahLaLa at 2:06 PM on July 9, 2022 [1 favorite]

I have not had kidney stone pain, but have had to deal with some pretty severe pain. I did take both Naproxen and Tylenol (paracetamol) at the same time for a bit. (You really want to be careful not to exceed the dosage of either though.) It sort of helped the pain.

I am really sensitive to opioids. What I have found is I can tolerate hydrocodone by taking it with some food, and also only taking half a pill rather than the full pill. I'm older than you but am also a short overweight woman so maybe my experience, while anecdata, may be helpful for you.
posted by gudrun at 2:18 PM on July 9, 2022 [1 favorite]

Don't not take a pain medication that is effective because you had a bad ride taking it the first time! Take it with food, as suggested. No need to blame the Sertraline when it is massively more likely to be a food issue.
posted by DarlingBri at 2:26 PM on July 9, 2022 [2 favorites]

Solidarity. I passed a 7 mm stone a few years ago. The worst month of my life.

Opioids make me vomit whether I take them with food or without and even when I take 1/4 of the prescribed dose. When I have kidney stones, Flomax + naproxen + acetomenophin have usually gotten me through the worst. When the pain is unbearable, I take 1/4 the prescribed dose, sleep for 2 hours, then vomit, because that's preferable to not sleeping at all.

I also sometimes use Phenazopyridine (sold in the US over the counter for UTI pain as AZO), which numbs the urinary tract. Do not take it before a doctor's appointment because it changes the color of your urine and will freak everyone out (and mess up tests). And I think the directions say not to take it for more than 2 days. But it is a great emergency backup for those moments when the pain is just unbearable.
posted by hydropsyche at 3:29 PM on July 9, 2022

Response by poster: Thanks everyone for the vibe check. I’m gonna hold off on taking any more opioids until I at least talk to my doctor and ask many questions. But I’ve taken a regular strength Tylenol just now and I’m hoping it helps with this headache I’ve got today as well as help with the kidney stone pain. I am very tired and feel puffy and achy all over after last night. Digestion isn’t back to par, either. But I think that’s probably to be expected. I’m going to focus on rest and hydration for now and get back to activity on Monday. Right now going up and down the stairs a few times is enough. Thanks for the sympathy.
posted by Mizu at 5:24 PM on July 9, 2022

Best answer: I’m an ER physician who is also a pain physician. It would be very unlikely at the doses described that you would have experienced serotonin syndrome. It’s not impossible, but very very unlikely. Hydrocodone is notorious for being poorly tolerated. You could call the ED nursing line and explain the reaction and see if they would switch you to OxyCodone or MSIR (morphine) which in general is very well tolerated. I never prescribe hydrocodone as it’s a weird half measure. As mentioned above Tylenol and ibuprofen is the bedrock of pain treatment. You can take them together (I would recommend 650 mg-1000mg of Tylenol, and 400 mg ibuprofen at the same time (there is no benefit to higher doses due to analgesic ceiling, higher doses are reserved for inflammatory states). Literature supports this combination as being equivalent to OxyCodone 5 mg in acute fracture pain. The only downside to taking them together is that you can’t take them more frequently (or alternating). The other key thing is hydration, as the more you drink the more you pee the faster the stone will pass. If you’re too nauseated to drink, ask for some zofran 4 mg ODT.

You should take no more than 4 grams of Tylenol or 2400 mg of ibuprofen a day.
posted by ghostpony at 5:29 PM on July 9, 2022 [20 favorites]

Response by poster: Follow up:

I’m happy to say I passed the wretched thing this morning! Begone!

I decided to take Tylenol four times a day for the first couple days after I asked this question. On Monday I got in touch with a NP who switched my rx to Oxy. The next day I could tell the pain was probably going to get worse that evening so I held off on the Tylenol so I could take the Oxycodone-acetaminophen after I forced myself to eat something. It did work and I didn’t get side effects, although I only had like maybe two hours where the pain was totally managed and I wasn’t woozy, but I couldn’t sleep at all. By the time it wore off entirely the pain had moved lower and wasn’t nearly so intense.

For the next couple days I took Tylenol at night to help me be comfortable sleeping. After a while I stopped and was just taking the naproxen twice daily. That continued and after a few days of very much UTI-like symptoms and very dull gut pain I woke up this morning and passed the stone! Pain started on July 4th, passed the sucker on the 20th. Only needed opioids the twice, and now I know what to expect for future stones (fingers crossed but better to be prepared.)

Thank you to all who expressed sympathy and super duper thank you to ghostpony for their expertise and clarity.
posted by Mizu at 9:51 AM on July 20, 2022