The DIRE score (Diagnosis, Intractability, Risk, Efficacy) can help to identify a patient with chronic noncancer pain who is likely to benefit from and to comply with long-term opioid maintenance therapy. The authors are from the University of Minnesota.
Patient selection: noncancer pain
Parameters:
(1) diagnosis (D)
(2) intractability (I)
(3) psychological risk (R)
(4) chemical health risk (R)
(5) reliability risk (R)
(6) social support risk (R)
(7) efficacy (of pain medication; E)
Parameter
Finding
Points
diagnosis
none definite or chronic condition with minimal objective findings
1
objective findings of moderate pain
2
objective findings of severe pain
3
intractability
few alternative therapies tried and patient has been passive
1
most customary treatments tried with patient not totally engaged or has barriers
2
inadequate response despite full spectrum of appropriate therapies tried and full patient engagement
3
psychological risk
serious mental illness or personality dysfunction
1
moderate
2
not significant, with good communication with clinic
3
chemical health risk
active or very recent misuse of drugs and/or alcohol
1
chemical coper or history of dependence in remission
2
no history of chemical dependency; not drug focused or chemically reliant
3
reliability risk
history of numerous problems
1
generally reliable with occasional problems with compliance
2
highly reliable
3
social support risk
poor support, few close relationships, loss of most normal life roles, socially isolated
1
reduction in some relationships and life roles
2
good support and relationships
3
efficacy (of pain medication)
poor; minimal pain relief despite moderate to high doses
1
moderate benefits or insufficient information
2
good improvement with stable dosing
3
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 7
• maximum score: 21
• The higher the score the better the outcome.
• A low score indicates that the patient is not an appropriate candidate for long-term opioid therapy. A score less than 14 is considered high risk.
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