Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    DIRE Score for Opioid Treatment

    Predicts compliance with opioid treatment for chronic noncancer pain.
    Favorite
    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:

    Please fill out required fields.

    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.

    Formula

    Addition of the selected points:

    Variable

    Points

    Diagnosis

    Benign chronic condition, minimal objective findings, or no definite diagnosis (examples: fibromyalgia, migraine headaches, non-specific back pain)

    1

    Slowly progressive condition concordant with moderate pain or fixed condition with moderate objective findings (examples: failed back surgery syndrome, back pain with moderate degenerative changes, neuropathic pain)

    2

    Advanced condition concordant with severe pain with objective findings (examples: severe ischemic vascular disease, advanced neuropathy, severe spinal stenosis)

    3

    Intractability

    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

    Psychological risk

    Serious personality dysfunction or mental illness interfering with care (examples: personality disorder, severe affective disorder, significant personality issues)

    1

    Personality or mental health interferes moderately (examples: depression or anxiety disorder)

    2

    Good communication with clinic, no significant personality dysfunction or mental illness

    3

    Chemical health risk

    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

    Reliability risk

    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

    Social support risk

    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

    Efficacy

    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

    Facts & Figures

    Interpretation:

    DIRE Score

    Candidacy for long-term opioid analgesia

    7-13

    Not a suitable candidate

    14-21

    Good candidate

    Dr. Miles J. Belgrade

    About the Creator

    Miles J. Belgrade, MD, is the medical director of Fairview Pain and Palliative Care Center. He is also an adjunct professor in the neurology department at University of Minnesota Medical School. Dr. Belgrade's primary research is focused on neuropathy, pain medicine, and treatment planning.

    To view Dr. Miles J. Belgrade's publications, visit PubMed

    About the Creator
    Dr. Miles J. Belgrade