Exam

DIRE Score

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DIRE Score

  • See Also
  1. Chronic Pain Management
  2. Opioid Risk Tool
  • Indications
  1. Assessment of a patient on selection for Chronic Opioid management
  • Criteria
  • Diagnosis
  1. Score 1: Benign chronic condition, minimal objective signs (e.g. Fibromyalgia, Migraines, low back)
  2. Score 2: Slowly progressive condition with moderate pain (e.g. failed back surgery, Neuropathy)
  3. Score 3: Advanced condition associated with severe pain (e.g. severe spinal stenosis)
  • Criteria
  • Intractability
  1. Score 1: Few therapies tried and patient is passively involved in management
  2. Score 2: Most therapies tried but patient not completely engaged in management, or barrier limited
  3. Score 3: Inadequate response to full spectrum of therapy despite maximally engaged patient
  • Criteria
  • Risk - Psychological
  1. Score 1: Serious mental illness or Personality Disorder
  2. Score 2: Moderate interference from mental health condition (e.g. depression, Anxiety Disorder)
  3. Score 3: No significant underlying mental illness and communicates well in clinic
  • Criteria
  • Risk - Chemical Health
  1. Score 1: Active or recent use of Illicit Drugs, excessive Alcohol or prescription drug use
  2. Score 2: Uses medications to cope with stress or prior Chemical Dependency now in remission
  3. Score 3: No Chemical Dependency or maladaptive medication use
  • Criteria
  • Risk - Reliability
  1. Score 1: Numerous problems with prior medications (misuse, missed appointments, non-compliant)
  2. Score 2: Generally reliable, but occasional lapses in compliance
  3. Score 3: Highly reliable patient
  • Criteria
  • Risk - Social Support
  1. Score 1: Chaotic life with minimal family support, close relationships or life roles
  2. Score 2: Relationships and life roles with some reduction
  3. Score 3: No social isolation with maintained family, friends and work/school involvement
  • Criteria
  • Efficacy
  1. Score 1: Minimal pain relief or poor function despite moderate to high doses
  2. Score 2: Moderate benefit with improved function or insufficient trial
  3. Score 3: Good improvement in pain, function, quality of life with stable doses over time
  • Scoring
  1. Add the 7 scores above (D + I + 4R + E) = 7 to 21
  • Interpretation
  1. Score 7-13: Not suitable candidate for longterm Opioid Analgesic therapy
  2. Score 14-21: Good candidate for longterm Opioid Analgesic therapy
  • References
  1. Belgrade (2009) Chronic Pain Managament UMN CME, Minneapolis