Pain Treatment Outcomes: The “4 A’s”

“Treatment outcomes” is the term used by healthcare providers that refers to benefits as well as side effects that result from a particular treatment, or combination of treatments, at a particular point in time. For chronic pain conditions, one way to categorize these is known as the “4 A’s”:

Analgesia (pain relief), Activities of Daily Living (ability to do things that you want or need to do), Adverse Effects (side effects), and Aberrant Behaviors (behaviors that may be warning signs for a problem with addiction).

The first “A” stands for “Analgesia” which refers to the amount of pain relief from current treatments. The standard measurement for this is the “1 to 10 scale.” Some people find this difficult to use, but it is an important tool for communication between the person who suffers from the pain condition and their treating physician. “10/10” represents “the worst pain you can imagine.” I often suggest that the chronic pain sufferer “imagine that all medication has been stopped--THIS would be 10/10.”
So to assess analgesia, or the amount of pain relief, the question becomes:
“WITH THE MEDICATION YOU ARE NOW TAKING, HOW MUCH LESS THAN 10/10 IS YOUR PAIN LEVEL? HOW MUCH BENEFIT ARE YOU GETTING FROM YOUR MEDICATION?”

The second “A” stands for “Activities of Daily Living, which refers to your ability to do things that you want or need to do. This begins with basic issues of taking care of yourself, and extends to your ability to perform activities as parent, spouse, friend, family member, work, hobbies, & community member, including religious activities. The goal here is for treatment to increase your ability to function in these areas.

Very often there are physical problems with being able to do things that you want or need to do, because some of these activities make pain worse, and may even do physical damage to bones, discs, joints, or soft tissues (tendons, ligaments)