Jaballah et al. conducted a five-year, single-blind, randomized, placebo-controlled study across four emergency departments in Tunisia to assess whether piroxicam or paracetamol could prevent pain recurrence and unplanned ED revisits after renal colic. A total of 1,383 adults (≥18 years) discharged after renal colic were randomized to one of three 5-day regimens: one oral piroxicam daily (20 mg) plus one placebo, 2g oral paracetamol daily, or two placebos only. Recurrence was defined as moderate-to-severe pain (numeric rating scale >3/10) within 7 days of discharge, assessed by telephone follow-up. The primary outcomes were recurrence of moderate-to-severe pain and unplanned ED revisits within 7 days. Pain recurred in approximately 30% of patients across all groups, and ~22% required ED revisit, with most events occurring within the first 48 hours. However, the piroxicam group experienced significantly more adverse effects, specifically gastrointestinal, compared to the paracetamol and placebo groups. The authors concluded that neither paracetamol nor piroxicam were effective in preventing the recurrence of RC symptoms or unplanned ED revisits. Limitations of the study included evaluation of only one type of NSAID (piroxicam) which limits generalizability to other agents, and the lack of objective adherence measures.