DIRE score

Indications

• patient selection for chronic opioid analgesia

Procedure

Diagnosis

• 1: benign chronic condition with minimal objective findings
  • fibromyalgia, migraine, low back pain
• 2: condition with moderate pain & objective findings
  • neuropathic pain, failed back surgery
• 3: severe pain with objective findings
  • severe ischemia, spinal stenosis, neuropathic pain

Intractability

• 1: few therapies tried; patient plays passive role in care
• 2: most customary treatments tried, but patient not fully engaged in pain management process or barriers in insurance, transportation, medical illness
• 3: patient fully engaged in pain management process, but with inadequate response

Risk

• psychologic
  • 1: personality disorder or mental illness interferes with care
  • 2: personality disorder or mental illness interferes only moderately
  • 3: good communication with clinic; no personality disorder or mental illness
• chemical health
  • 1: active or recent use of illicit drugs, alcohol abuse or prescription drug abuse
  • 2: uses medications to cope with stress or history of chemical dependency in remission
  • 3: no history of chemical dependency, drug abuse, alcoholism
• reliability
  • 1: history of multiple problems: medication misuse, medication non-compliance, missed appointments
  • 2: occasional medication non-compliance, but generally reliable
  • 3: highly reliable with medications, appointments, treatments
• social support
  • 1: life in chaos, little family support, few close relationships
  • 2: reduction in some relationships & life roles
  • 3: supportive family, close relationships, involved in work or school

Efficacy

• 1: poor function or minimal pain relief despited moderate to high doses
• 2: moderate benefit with function or hasn't tried opiate in adequate dose for sufficient time
• 3: good improvement in pain, function, & quality of life with stable doses over time

More general terms

• numerical rating scale (NRS)