DIRE score for opioid prescription in chronic pain
Diagnosis
Benign chronic condition, minimal objective findings or no definite diagnosis (such as fibromyalgia, migraine headaches, non-specific back pain)
Slowly progressive condition concordant with moderate pain or fixed condition with moderate objective findings (such as failed back surgery syndrome, back pain with moderate degenerative changes, neuropathic pain)
Advanced condition concordant with severe pain with objective findings (such as severe ischemic vascular disease, advanced neuropathy, severe spinal stenosis)
Intractability
Few therapies tried, patient takes a passive role in pain management process
Most customary treatments have been tried but patient not fully engaged in pain management process or barriers prevent (examples: insurance, transportation, medical illness)
Patient fully engaged in spectrum of appropriate treatments but with inadequate response
Psychological risk
Serious personality dysfunction or mental illness interfering with care (such as personality disorder, severe affective disorder, significant personality issues)
Personality or mental health interferes moderately (such as depression or anxiety disorder)
Good communication with clinic, no significant personality dysfunction or mental illness
Chemical health risk
Active or very recent use of illicit drugs, excessive alcohol, or prescription drug abuse
Chemical coper (uses medications to cope with stress) or history of chemical dependence in remission
No chemical dependence history, not drug-focused or chemically reliant
Reliability risk
History of numerous problems (medication misuse, missed appointments, rarely follows through)
Occasional difficulties with compliance but generally reliable
Highly reliable patient with meds, appointments, and treatment
Social support risk
Life in chaos, little family support, few close relationships, loss of most normal life roles
Reduction in some relationships and life roles
Supportive family/close relationships, involved in work or school and no social isolation
Efficacy
Poor function or minimal pain relief despite moderate to high doses
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)
Good improvement in pain/function and QoL with stable doses over time
Please complete all sections.
Reference
Miles J Belgrade, Cassandra D Schamber, Bruce R Lindgren. The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006 Sep;7(9):671-81.
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