title: Outpatient management of biliary colic: a prospective observational study of prescribing habits and analgesia effectiveness.
abstract: BACKGROUND
  Uncomplicated biliary colic presents a significant health and financial burden to hospitals and primary care services alike. There is little guidance on the correct analgesia to use on an outpatient basis. This study aimed to evaluate the effectiveness of oral analgesics on biliary colic pain and to explore the prescribing habits of community doctors.
  
  
  METHODS
  Consecutive patients with ultrasound proven symptomatic gallstones completed a questionnaire recording demographics and symptomatology. Pain was assessed using a visual analogue scale (VAS) based on the Biliary Symptom Score (BSS) to evaluate the effectiveness of various analgesic agents. Local General Practitioners were also surveyed to establish prescribing practices.
  
  
  RESULTS
  Co-Codamol had the highest mean effectiveness VAS score (6.5/10). Patients with increased BMI, short symptom duration and a BSS >70 were most likely to suffer from severe pain. Patients in a subgroup with severe pain were most likely to have their pain reduced by NSAID analgesia compared to no NSAID (OR 2.20, p = 0.027). This effect remained significant upon multivariable regression (OR 2.52, p = 0.018) in a model containing age and NSAIDs. There was wide variation in the prescribing practice of GPs and hospital doctors.
  
  
  CONCLUSIONS
  The range of drugs prescribed for biliary colic is extensive with little evidence base. In this study NSAIDs were the most effective analgesia for patients with severe pain. In the absence of contraindications to their use, physician education or guidance emphasizing the benefits of NSAIDs may potentially reduce symptomatic hospital presentation and admissions for biliary colic.
authors.affiliation: Dept. of General Surgery, University Hospital of Coventry & Warwickshire, Coventry, UK; Dept. of Surgery & Cancer, Imperial College London, London, UK. Electronic address: maxj101@gmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Johnston
authors.affiliation: Dept. of General Surgery, Chelsea & Westminster Hospital, London, UK.
authors.forename: J E F
authors.initials: JE
authors.lastname: Fitzgerald
authors.affiliation: Dept. of General Surgery, Chelsea & Westminster Hospital, London, UK; Dept. of Surgery & Cancer, Imperial College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bhangu
authors.affiliation: Dept. of General Surgery, University Hospital of Coventry & Warwickshire, Coventry, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Greaves
authors.affiliation: Dept. of General Surgery, University Hospital of Coventry & Warwickshire, Coventry, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Prew
authors.affiliation: Dept. of General Surgery, University Hospital of Coventry & Warwickshire, Coventry, UK.
authors.forename: I
authors.initials: I
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001660:Biliary Tract Diseases / Q000188:drug therapy*; D003085:Colic / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: Analgesia; Biliary colic; Outpatient