opioid use

DIRE Score for Appropriate Opioid Use
Tool for assessing the appropriateness of chronic opioid therapy.

1. Diagnosis --> [select name="Q1" value="Choice A=1|Choice B=2|Choice C=3"]
A. Benign chronic condition, minimal objective signs (e.g. Fibromyalgia, Migraines, low back) - 1 point
B. Slowly progressive condition with moderate pain (e.g. failed back surgery, Neuropathy) - 2 points
C. Advanced condition associated with severe pain (e.g. severe spinal stenosis) - 3 points

2. Intractability --> [select name="Q2" value="Choice A=1|Choice B=2|Choice C=3"]
A. Few therapies tried and patient is passively involved in management - 1 point
B. Most therapies tried but patient not completely engaged in management, or barrier limited - 2 points
C. Inadequate response to full spectrum of therapy despite maximally engaged patient - 3 points

3. Risk - Psychological --> [select name="Q3" value="Choice A=1|Choice B=2|Choice C=3"]
A. Serious mental illness or Personality Disorder - 1 point
B. Moderate interference from mental health condition (e.g. depression, Anxiety Disorder) - 2 points
C. No significant underlying mental illness and communicates well in clinic - 3 points

4. Risk - Chemical Health --> [select name="Q4" value="Choice A=1|Choice B=2|Choice C=3"]
A. Active or recent use of Illicit Drugs, excessive Alcohol or prescription drug use - 1 point
B. Uses medications to cope with stress or prior Chemical Dependency now in remission - 2 points
C. No Chemical Dependency or maladaptive medication use - 3 points

5. Risk - Reliability --> [select name="Q5" value="Choice A=1|Choice B=2|Choice C=3"]
A. Numerous problems with prior medications (misuse, missed appointments, non-compliant) - 1 point
B. Generally reliable, but occasional lapses in compliance - 2 points
C. Highly reliable patient - 3 points

6. Risk - Social Support --> [select name="Q6" value="Choice A=1|Choice B=2|Choice C=3"]
A. Chaotic life with minimal family support, close relationships or life roles - 1 point
B. Relationships and life roles with some reduction - 2 points
C. No social isolation with maintained family, friends and work/school involvement - 3 points

7. Efficacy --> [select name="Q7" value="Choice A=1|Choice B=2|Choice C=3"]
A. Minimal pain relief or poor function despite moderate to high doses - 1 point
B. Moderate benefit with improved function or insufficient trial - 2 points
C. Good improvement in pain, function, quality of life with stable doses over time - 3 points

Score --> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)" memo="score"] out of 21
Interpretation --> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7);score>13?'Good candidate for longterm opioid analgesic therapy':'Not suitable candidate for longterm opioid analgesic therapy'" memo="interpretation"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference:
[link url="//www.ncbi.nlm.nih.gov/pubmed/16942953" memo="#1"] Belgrade (2006) J Pain 7:671-81.
[link url="//www.fpnotebook.com/rheum/exam/DrScr.htm" memo="#2"] FPNotebook page
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