DIRE Score for Opioid Treatment
Predicts compliance with opioid treatment for chronic noncancer pain.
Benign chronic condition, minimal objective findings, or no definite diagnosis+1
Slowly progressive condition concordant with moderate pain or fixed condition with moderate objective findings+2
Advanced condition concordant with severe pain with objective findings+3
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
Serious personality dysfunction or mental illness interfering with care+1
Personality or mental health interferes moderately+2
Good communication with clinic, no significant personality dysfunction or mental illness+3
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
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
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
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