Ketorolac (Toradol) Pain Shot, 15 mg

What it is

Ketorolac belongs to the same family as ibuprofen and naproxen — the non-steroidal anti-inflammatory drugs — and works the same way, by blocking the body's production of a substance behind pain, fever, and inflammation. What sets it apart is its strength and its route: it is given into a vein or into a muscle for pain described as moderately severe, the kind usually reached for after surgery or during an acute attack of something painful. It is not an opioid and does not act on the same receptors, which is why it appears so often where a clinician wants real pain relief without reaching for one. It is explicitly a short-course drug — the labelling limits how many days in a row it may be used, counting any oral tablets that follow the injection — and it is not intended for mild or long-standing pain.

Why it is done

• To control moderately severe pain after an operation, often alongside or instead of an opioid
• To treat an acute painful episode in an emergency department or urgent care setting, such as a kidney stone or a severe migraine
• To reduce pain in someone who cannot take medicine by mouth
• To provide anti-inflammatory pain relief when the intention is a short course and not ongoing treatment

What to expect

Given into a muscle it stings for a moment; given into a drip it is not felt beyond the line already in place. Relief generally builds over the following half hour. Because it is an anti-inflammatory, it carries that group's familiar cautions — stomach irritation and bleeding, effects on the kidneys, and interactions with blood thinners — which is part of why it is kept to a short course and why the prescriber will ask about stomach ulcers, kidney problems, and other medicines beforehand. A single injection is often the whole of the treatment; sometimes a short run of tablets follows it. The listed unit here is a concentration, and what is billed reflects how much was actually given.

Questions worth asking

• How many units of the drug were billed, and does that match the dose recorded in the notes?
• Is there a separate charge for administering the injection, on top of this drug charge?
• If this was given in an emergency department, how does the charge compare with the same drug given in a clinic or a surgical centre?
• If the drug was drawn from a larger vial and part of it discarded, is the discarded portion also being billed?
• Was a tablet form offered as an alternative, and what would that route have cost?