DIRE Score for Opioid TreatmentLoading...DiagnosisBenign chronic condition, minimal objective findings, or no definite diagnosis+1Slowly progressive condition concordant with moderate pain or fixed condition with moderate objective findings+2Advanced condition concordant with severe pain with objective findings+3IntractabilityFew therapies tried; patient takes a passive role in pain management process+1Most customary treatments have been tried but patient not fully engaged in pain management process or barriers prevent+2Patient fully engaged in spectrum of appropriate treatments but with inadequate response+3Psychological riskSerious personality dysfunction or mental illness interfering with care+1Personality or mental health interferes moderately+2Good communication with clinic, no significant personality dysfunction or mental illness+3Chemical health riskActive or very recent use of illicit drugs, excessive alcohol or prescription drug abuse+1Chemical coper or history of chemical dependence in remission+2No CD history, not drug-focused or chemically reliant+3Reliability riskHistory of numerous problems+1Occasional difficulties with compliance but generally reliable+2Highly reliable patient with meds, appointments, and treatment+3Social support riskLife in chaos, little family support, few close relationships, loss of most normal life roles+1Reduction in some relationships and life roles+2Supportive family/close relationships, involved in work or school and no social isolation+3EfficacyPoor function or minimal pain relief despite moderate to high doses+1Moderate benefit with improved function in a number of ways+2Good improvement in pain/function and quality of life with stable doses over time+3Indications for UseInsights & Cautions