Description

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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