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    DIRE Score for Opioid Treatment

    Predicts compliance with opioid treatment for chronic noncancer pain.
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    Why Use

    No prospective external validation exists that we are aware of, but the American Academy of Pain Medicine recommends the DIRE Score as a potential tool to assess abuse risk (strong recommendation, low quality evidence) (Chou 2009).

    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
    Life in chaos, little family support, few close relationships, loss of most normal life roles
    +1
    Reduction in some relationships and life roles
    +2
    Supportive family/close relationships, involved in work or school and no social isolation
    +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

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Evidence on treating chronic noncancer pain is limited. Use best available evidence, alongside clinical judgment, in deciding whether to initiate opioids.

    About the Creator
    Dr. Miles J. Belgrade
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