The DIRE Score: Predicting Outcomes of Opioid Prescribing for Chronic Pain
The DIRE Score is a clinician rating used to predict patient suitability for long-term opioid analgesic treatment for chronic non-cancer pain. It consists of four factors that are rated separately and then added up to form the DIRE score: Diagnosis, Intractability, Risk and Efficacy. The Risk factor is further broken down into four subcategories that are individually rated and added together to arrive at the Risk score. The Risk subcategories are Psychological Health, Chemical Health, Reliability, and Social Support. Each factor is rated on a numerical scale from 1 to 3, with 1 corre- sponding to the least compelling or least favorable case for opioid prescribing, and 3 denoting the most compelling or favorable case for opioid prescribing. The total score is used to determine whether or not a patient is a suitable candidate for opioid maintenance analgesia. Scores may range from 7 at the lowest (patient receives all 1s) to 21 at the highest (patient receives all 3s).