DIRE Score for Opioid Treatment
Predicts compliance with opioid treatment for chronic noncancer pain.
Why Use
Benign chronic condition, minimal objective findings, or no definite diagnosis
+1Slowly progressive condition concordant with moderate pain or fixed condition with moderate objective findings
+2Advanced condition concordant with severe pain with objective findings
+3Few therapies tried; patient takes a passive role in pain management process
+1Most customary treatments have been tried but patient not fully engaged in pain management process or barriers prevent (examples: insurance, transportation, medical illness)
+2Patient fully engaged in spectrum of appropriate treatments but with inadequate response
+3Serious personality dysfunction or mental illness interfering with care
+1Personality or mental health interferes moderately
+2Good communication with clinic, no significant personality dysfunction or mental illness
+3Active or very recent use of illicit drugs, excessive alcohol, or prescription drug abuse
+1Chemical coper (uses medications to cope with stress) or history of chemical dependence (CD) in remission
+2No CD history, not drug-focused or chemically reliant
+3History of numerous problems (medication misuse, missed appointments, rarely follows through)
+1Occasional difficulties with compliance but generally reliable
+2Highly reliable patient with meds, appointments, and treatment
+3Life in chaos, little family support, few close relationships, loss of most normal life roles
+1Reduction in some relationships and life roles
+2Supportive family/close relationships, involved in work or school and no social isolation
+3Poor function or minimal pain relief despite moderate to high doses
+1Moderate benefit with improved function in a number of ways (or insufficient information, hasn’t tried opioid yet, or very low doses/trial too short)
+2Good improvement in pain/function and quality of life with stable doses over time
+3Result:
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