Can you imagine being dropped off at the emergency room by your wife and toddler on Friday the 13th at the beginning of a pandemic for what ended up being a 3-month-long excruciating journey of pain, only to find that the ER was also being remodeled at the time? Well, that was the beginning of a “COVID Kidney Stone Journey” for “Pain GuyTM”. That story is the kindling for this overall presentation with a dynamic look at taking care of patients with kidney stones experiencing incredible pain. Kidney stone pain (nephrolithiasis) has been compared to various other incredible instances of pain such as broken femurs, bear mauling’s, and even childbirth. In this presentation, we will first review nephrolithiasis symptoms, diagnosis, and the appreciable treatment and mitigation options. We will then comprehensively review pain management best practices such as pain scales, opioid risk screenings, and prescription drug monitoring programs, amongst others. Finally, we will also navigate clinical realms and pearls involving morphine milligram equivalents (MMEs), NSAID and Opioid pharmacology, amongst others. All-in-all, arming healthcare professionals with the knowledge, tools, and skills needed to help patient in pain with nephrolithiasis.