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DIRE Score

DIRE Score - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires


D.I.R.E. Score: Patient Selection for Chronic Opioid Analgesia
For each factor, rate the patient’s score from 1-3 based on the explanations in the right-hand column
SCORE FACTOR EXPLANATION

DIAGNOSIS
1 = Benign chronic condition with minimal objective findings or no definite medical diagnosis.
Examples: fibromyalgia, migraine headaches, non-specific back pain.
2 = 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.
3 = Advanced condition concordant with severe pain with objective findings. Examples: severe
ischemic vascular disease, advanced neuropathy, severe spinal stenosis.

INTRACTABILITY

1 = Few therapies have been tried and the patient takes a passive role in his/her pain
management process.
2 = Most customary treatments have been tried but the patient is not fully engaged in the pain
management process, or barriers prevent (insurance, transportation, medical illness).
3 = Patient fully engaged in a spectrum of appropriate treatments but with inadequate
response.

RISK (R = Total of P+C+R+S below)

Psychological
1 = Serious personality dysfunction or mental illness interfering with care. Example:
personality disorder, severe affective disorder, significant personality issues.
2 = Personality or mental health interferes moderately. Example: depression or anxiety
disorder.
3 = Good communication with clinic. No significant personality dysfunction or mental illness.

Chemical Health
1 = Active or very recent use of illicit drugs, excessive alcohol, or prescription drug abuse.
2 = Chemical coper (uses medications to cope with stress) or history of chemical dependence
(CD) in remission.
3 = No CD history. Not drug-focused or chemically reliant.


Reliability

1 = History of numerous problems: medication misuse, missed appointments, rarely follows
through.
2 = Occasional difficulties with compliance, but generally reliable.
3 = Highly reliable patient with meds, appointments & treatment.


Social Support
1 = Life in chaos. Little family support and few close relationships. Loss of most normal life
roles.
2 = Reduction in some relationships and life roles.
3 = Supportive family/close relationships. Involved in work or school and no social isolation.


EFFICACY
SCORE

1 = Poor function or minimal pain relief despite moderate to high doses.
2 = Moderate benefit with function improved in a number of ways (or insufficient info – hasn’t
tried opioid yet or very low doses or too short of a trial).
3 = Good improvement in pain and function and quality of life with stable doses over time.


Total score = D + I + R + E

Score 7-13: Not a suitable candidate for long-term opioid analgesia
Score 14-21: May be a good candidate for long-term opioid analgesia

Used with permission by Miles J. Belgrade, MD