DIRE Score (Diagnosis, Intractability, Risk, Efficacy)
Predicts suitability for long-term opioid therapy in chronic non-cancer pain
- Highest activation tier
- Recommended
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- questionnaire
- Care settings
- Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The DIRE Score (Diagnosis, Intractability, Risk, Efficacy) can activate when the transcript or pasted chart context documents any of these:
- Chronic opioid therapy candidacy
- Long-term opioid suitability assessment
Inputs the note needs
1 input. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| DIRE total score (7-21) | history |
Scoring
4 factors (Diagnosis, Intractability, Risk, Efficacy) each scored 1-3. Risk has 4 subfactors. Total 7-21.
Interpretation
≥14: Suitable candidate for long-term opioid therapy. <14: Not a suitable candidate — consider alternatives.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Belgrade 2006.
- Belgrade MJ et al. The DIRE score: predicting outcomes of opioid prescribing for chronic painBelgrade et al. (DIRE) 2006 · 2006 · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the DIRE Score (Diagnosis, Intractability, Risk, Efficacy) (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated DIRE Score (Diagnosis, Intractability, Risk, Efficacy) value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a questionnaire: a patient-reported or clinician-rated instrument, where a spare activation carries low harm.
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