“Agonising pain in my side, coming in waves and shooting to my groin — I can’t keep still”

Sudden severe COLICKY LOIN pain radiating to the GROIN, in waves, with the patient RESTLESS and unable to get comfortable (a discriminator from peritonitis, where patients lie still), plus nausea/vomiting and HAEMATURIA, is the classic picture of RENAL/URETERIC COLIC from a stone. Provide prompt effective ANALGESIA — an NSAID by any route is first-line (NICE NG118; e.g. diclofenac PR/IM, which needs a face-to-face assessment) unless contraindicated (MHRA June 2013: diclofenac contraindicated in established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease and congestive heart failure), then IV paracetamol, then an opioid only if both are contraindicated or insufficient, plus an antiemetic — as an early priority alongside assessment. Critically, do NOT anchor on "just a stone": exclude the dangerous MIMICS, above all a leaking/ruptured ABDOMINAL AORTIC ANEURYSM (especially in older or vascular patients presenting with loin/back pain — rapidly fatal, needs emergency vascular assessment), an INFECTED OBSTRUCTED kidney (fever/sepsis with obstruction is a urological emergency needing urgent decompression), ECTOPIC pregnancy (always pregnancy-test women of childbearing age), and other acute-abdomen causes. Investigate with a urine dip (blood supports the diagnosis but its absence does not exclude it) and an urgent LOW-DOSE NON-CONTRAST CT-KUB within 24 hours as the imaging of choice (confirming stone size/site/obstruction), plus U&E (AKI), FBC/CRP, and a pregnancy test (ultrasound if pregnant/young). Recognise admission/urgent-referral criteria — infection with obstruction, AKI, single/transplant kidney, uncontrolled pain/vomiting, large/high stone, dehydration, bilateral obstruction, uncertainty — while small distal stones often pass with analgesia, hydration and follow-up. Safety-net for fever/rigors, uncontrolled pain, anuria or feeling very unwell, and advise on stone passage and recurrence prevention.