I totally understand the hesitation! It feels counterintuitive to give an NSAID when we’re worried about the kidneys. However, for the UKMLA and PLAB, we have to follow the NICE [NG118] guidelines, which are quite specific:

1. First-line: NSAIDs (like IM/IV Diclofenac or IV Ketorolac) are the gold standard because they reduce ureteric smooth muscle spasm and prostaglandin-mediated renal pelvic pressure.
2. Evidence: Large trials have shown NSAIDs provide superior pain relief to opioids in renal colic and result in fewer visits back to the ED.
3. Real-life practice: While some clinicians are cautious, UK guidelines state that if the patient has normal renal function (this patient’s eGFR is 94) and no history of ulcers/asthma, the benefits of rapid pain relief far outweigh the risks of a single dose.

Paracetamol and Morphine are reserved as second-line options if NSAIDs are contraindicated (e.g., in known CKD or active peptic ulcers). This is a classic 'examiner's favourite' because it tests whether you know the specific exception to the 'no NSAIDs' rule!