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Pain

DIRE Score calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

Diagnosis

1: benign or minimal objective findings. 2: slowly progressive or fixed condition with moderate findings. 3: advanced condition with severe pain and objective findings.

Intractability

1: few therapies and a passive role. 2: most customary treatments tried, with incomplete engagement or barriers. 3: fully engaged, and the response is still inadequate.

Psychological health

Risk subscore. 1 is least favorable and 3 is most favorable.

Chemical health

Risk subscore for alcohol and other substance history. 1 is least favorable and 3 is most favorable.

Reliability

Risk subscore. 1 is least favorable and 3 is most favorable.

Social support

Risk subscore. 1 is least favorable and 3 is most favorable.

Efficacy

1: poor function or minimal relief despite moderate or high doses. 2: moderate benefit, or too little information because there was no trial, the dose was very low, or the trial was too short. 3: good improvement with stable doses.

Result

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Clinical inputs

  • Diagnosis
  • Intractability
  • Psychological health
  • Chemical health
  • Reliability
  • Social support
  • Efficacy

Primary source

Belgrade MJ, Schamber CD, Lindgren BR. The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain. DOI: 10.1016/j.jpain.2006.03.001. PMID: 16942953. Diagnosis, intractability, and efficacy are each 1, 2, or 3. Risk is the sum of psychological health, chemical health, reliability, and social support, each 1, 2, or 3. Total = diagnosis + intractability + risk + efficacy, from 7 to 21. Scores 7–13 are not suitable for long-term opioid analgesia. Scores 14–21 are suitable. At those cutoffs, sensitivity and specificity were 94% and 87% for compliance, 81% and 76% for efficacy, and 86% and 73% for continuing versus stopping opioids. (2006)

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