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DIRE Score for Opioid Treatment
Predicts compliance and analgesic benefit before starting long-term opioid therapy for chronic pain.
DIRE Score for Opioid Treatment
Diagnosis
How well the underlying diagnosis accounts for the pain.
Intractability
Extent to which reasonable non-opioid therapies have already been tried.
Risk — psychological
Risk — chemical health
Risk — reliability
Risk — social support
Efficacy of trialled or current analgesia
Result14 points
Score ≥14 favours long-term opioid analgesia — the patient profile is associated with good compliance and analgesic benefit.
- Diagnosis + Intractability
- 4
- Risk subtotal
- 8
- Efficacy
- 2
When to use
- Before initiating long-term opioid therapy for chronic non-cancer pain, to structure the discussion of diagnosis, prior treatment, risk, and expected benefit.
- Periodic reassessment of a patient already on maintenance opioid therapy.
Formula
DIRE = Diagnosis (1-3) + Intractability (1-3) + Risk [Psychological (1-3) + Chemical health (1-3) + Reliability (1-3) + Social support (1-3)] + Efficacy (1-3). Range 7-21; score ≥14 suggests a good candidate for long-term opioid analgesia, <14 suggests a poor candidate.
Pearls and pitfalls
- Developed and validated retrospectively in a single pain-centre cohort (n=61); treat as a structured aid, not a substitute for clinical judgement.
- The four Risk domains are scored and summed separately before being added to Diagnosis, Intractability, and Efficacy.