Pain due to spasm of visceral smooth muscle, e.g. biliary, renal colic, when severe, requires a substantial dose of morphine, pethidine or buprenorphine. These drugs themselves cause spasm of visceral smooth muscle and so have a simultaneous action tending to increase the pain. Phenazocine and buprenorphine are less liable to cause spasm. An antimuscarinic drug such as atropine or hyoscine may be given simultaneously to antagonise this effect.
Prostaglandins are involved in control of smooth muscle and colic can be treated with NSAIDs, e.g. diclofenac, indometacin (i.m., suppository or oral).
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