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Implication for health policy/practice/research/medical education: Several drugs and methods are being evaluated for aimed at pain control for renal stones during ESWL. This study investigates the effect of EMLA cream on patient-controlled analgesia with remifentanil during the ESWL procedure. 1. Background Extracorporeal shock wave lithotripsy (ESWL), the most com-monly used procedure for the treatment of kidney stones, is painful based on the power of the acoustic shock waves ap-plied (1). Though believed to be multifactorial, the pathogen-esis of the pain during ESWL remains to be elucidated. The cu-taneous superficial skin nociceptors and visceral nociceptors such as periosteal, pleural, peritoneal and/or musculoskeletal Background: To alleviate stinging pain in the skin entry area and visceral discomfort in patients who are undergoing ESWL. Objectives: This study was designed to investigate the effectiveness of the EMLA cream in combination with remifentanil patient-controlled analgesia (PCA) in patients undergo