DIRE Score for Opioid Treatment

Addition of the selected points: Variable Points Diagnosis Benign chronic condition, minimal objective findings, or no definite diagnosis (examples: fibromyalgia, migraine headaches, non-specific back pain) 1 Slowly progressive condition concordant with moderate pain or fixed condition with moderate objective findings (examples: failed back surgery syndrome, back pain with moderate degenerative changes, neuropathic pain) 2 Advanced condition concordant with severe pain with objective findings (examples: severe ischemic vascular disease, advanced neuropathy, severe spinal stenosis) 3 Intractability Few therapies tried; patient takes a passive role in pain management process 1 Most customary treatments have been tried but patient not fully engaged in pain management process or barriers prevent (examples: insurance, transportation, medical illness) 2 Patient fully engaged in spectrum of appropriate treatments but with inadequate response 3 Psychological risk Serious personality dysfunction or mental illness interfering with care (examples: personality disorder, severe affective disorder, significant personality issues) 1 Personality or mental health interferes moderately (examples: depression or anxiety disorder) 2 Good communication with clinic, no significant personality dysfunction or mental illness 3 Chemical health risk Active or very recent use of illicit drugs, excessive alcohol, or prescription drug abuse 1 Chemical coper (uses medications to cope with stress) or history of chemical dependence (CD) in remission 2 No CD history, not drug-focused or chemically reliant 3 Reliability risk History of numerous problems (medication misuse, missed appointments, rarely follows through) 1 Occasional difficulties with compliance but generally reliable 2 Highly reliable patient with meds, appointments, and treatment 3 Social support risk Life in chaos, little family support, few close relationships, loss of most normal life roles 1 Reduction in some relationships and life roles 2 Supportive family/close relationships, involved in work or school and no social isolation 3 Efficacy Poor function or minimal pain relief despite moderate to high doses 1 Moderate benefit with improved function in a number of ways (or insufficient information, hasn’t tried opioid yet, or very low doses/trial too short) 2 Good improvement in pain/function and quality of life with stable doses over time 3