Sialolithiasis

Summary

This chapter discusses the role of NSAIDs, opioids, and sialogogues in sialolithiasis. Conservative treatment of sialolithiasis pain consists of sialagogues (e.g. lemon drops), mild analgesics (e.g. acetaminophen, NSAIDs), opioids, mechanical stimulation, and warm compresses. A variety of non-pharmacological treatment modalities may be necessary if pharmacotherapy fails. The goal of drug therapy is to temporize until, and hopefully facilitate (in the case of sialogogues), passage of the stone. Given the importance of surgical intervention to relieve salivary tract stone disease (and symptoms), it is not surprising that no clinical trials assess the comparative efficacy of drug treatment options for treating sialolithiasis pain. NSAIDs, acetaminophen, and various opioids (e.g. hydrocodone, oxycodone) are usually recommended. Given the inflammatory component to parotitis and sialolithiasis, NSAIDs are the most reasonable initial choice, but it must be acknowledged that there is little evidence basis for treatment decisions in this population.