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.
Specialty: Pharmacology, clinical