DIRE Score

Is the condition objectively capable of causing severe pain?

Diagnosis Assessment

Have other treatments failed?

Intractability Evaluation

Assessing psychosocial and chemical stability.

Psychological Health

Chemical Health

Reliability

Social Support

Has the patient previously responded well to opioids without escalating dose?

Efficacy Check

Total DIRE Score

0/ 21

Not a Candidate

Opioid adherence and efficacy are highly unlikely.

Guidelines & Evidence

Verified

Last Review: 2026

Used clinically by primary care and pain specialists to justify the initiation or continuation of long-term opioid therapy.

Best applied when considering placing a patient with chronic non-cancer pain on a continuous opioid contract.

Last Comprehensive Review: 2026