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Do you know what NNT stands for?

What are the odds that painkiller is doing you more harm than good?

question-marks-on-blue-gradientHave you ever heard the term “number needed to treat,” also known as “NNT?”

It’s a measure used to determine how many people must be treated with a medication for it to benefit one person. The higher a medication’s NNT number, the fewer people it will help. With any medication, there is a percentage of people for whom it will have a positive effect, a percentage of people for whom it will have no effect and a percentage for whom it will do more harm than good due to the medication’s side effects.

When you take any medication for any reason, it’s always important to understand and weigh the potential benefits against the potential harm.

Take the example of a condition that has a high likelihood of being fatal, such as untreated Type 2 Diabetes or advanced heart disease. A drug that’s proven to benefit only 10 per cent of those who take it may still be considered worthwhile if the alternative for that 10 per cent is high risk of death, even if there are risky side effects associated with the drug’s use.

Remember — every medication comes with its side effects, ranging from mild to severe and common to rare. As we have said before, reliance on any medication, either off the shelf or by prescription, should be avoided if possible through changes in lifestyle (such as diet or exercise) or an intervention such as Chiropractic care.

As Chiropractors, painkillers and anti-inflammatories are the most common medications that concern us. Too often, patients have become chronic users of these medications to deal with chronic pain, but this only masks the symptom – a pill does nothing to treat the underlying cause of the pain.

And how good of a job do these medications really do versus the risk anyway?

According to a report by the U.S. National Safety Council, a painkiller that provides at least 50 per cent pain relief is considered effective. How many people must be treated before one person experiences even that degree of relief? Let’s look at a few examples from that report:

Oxycodone 15 mg –NNT of 4.6: Instead of trying to wrap your head around the idea of 4.6 people, let’s look at it this way. You would have to treat 46 people for 10 to get 50 percent relief of their pain. Thirty-six of those 46 people would not get adequate pain relief. But oxycodone is an opioid drug. Opioids are addictive drugs that can cause sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and even death. Your body can also build a tolerance, requiring higher doses over time for continued effectiveness.

Think about that – most of the people using oxycodone are risking all those side effects, including addiction, and the drug isn’t even helping them.

Naproxen 500 mg – NNT of 2.7: Naproxen is not an opioid but in the NSAID family of medications, with brands that include Aleve. With an NNT of 2.7, it is more effective for more people than oxycodone, but it too has side effects, including indigestion, heartburn, stomach pain, nausea, headache, dizziness, drowsiness, bruising, itching, and rash.

Ibuprofen 200 mg + acetaminophen 500 mg – NNT of 1.6: The old Advil and Tylenol combo. Its NNT makes it the most effective pain reliever of all, even compared to addictive opioids. Treat 16 people and 10 will see effective relief. Six will not.

Tylenol (acetaminophen) regularly makes headlines for all the wrong reasons. A Health Canada report in 2015 found that there are about 4,000 hospitalizations a year in this country due to acetaminophen overdoses. It is considered a leading cause of all serious liver injuries, including liver failure.

A study last year published by the Journal of the American Medical Association found that about half of pregnant women in the U.S. and Europe use acetaminophen during pregnancy for pain and fever relief. But use of the drug during pregnancy was found to increase risk of “multiple behavourial difficulties” in children. These include ADHD-like conditions and autism-spectrum disorders. It was even associated with increased risk of cryptorchidism – boys born with one or both testes undescended.

Treat the cause, not the symptom

Which once again brings us back to our key point – the best thing you can do for your health is get to the root cause of your pain and address that to avoid dependence on any medication.

As Chiropractors, we know that not ALL drugs are unnecessary. Some are needed in life-threatening situations. But as healthcare providers, we always urge our patients to fully understand the implications associated with anything they put in their bodies. Before consigning yourself to long-term use of any medication, always consider how changes in your lifestyle habits and incorporating Chiropractic care to improve your brain-body connection could be the better alternative.

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