Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The DIRE score calculator helps determine a patient's suitability for long-term opioid analgesia by assessing various aspects of their pain management and personal circumstances. This evaluation takes into account the following factors:

- Diagnosis: The nature and severity of the patient's medical condition.
- Intractability: The extent of treatments tried and the patient's engagement in their pain management.
- Psychological Risk: The impact of mental health on the patient's ability to undergo treatment.
- Chemical Health Risk: The patient's history or current use of substances.
- Reliability Risk: The patient's consistency in adhering to treatment plans.
- Social Support Risk: The stability of the patient's social environment and support system.
- Efficacy: The effectiveness of opioid treatment in improving pain and function.

Each factor is scored on a scale from 1 to 3. For Diagnosis, for example, a benign condition earns a 1, while an advanced condition earns a 3. This scoring continues through each factor:

- Intractability ranges from minimal effort in managing pain (1) to full engagement but inadequate response (3).
- Psychological Risk evaluates serious personality dysfunctions (1) to good communication and no significant psychological issues (3).
- Chemical Health Risk considers active substance abuse (1) to no history of chemical dependence (3).
- Reliability Risk scores numerous compliance issues (1) to high reliability (3).
- Social Support Risk ranges from chaotic lifestyle (1) to strong supportive relationships (3).
- Efficacy varies from poor function despite treatment (1) to considerable improvement and stable dosing (3).

The scores from each category are added together, resulting in a total score between 7 and 21. This total informs the interpretation:

- If the total score is 13 or less, the patient is deemed not suitable for long-term opioid analgesia.
- A total of 14 or more suggests the patient is a good candidate for such treatment.

This comprehensive scoring approach ensures that decisions related to opioid therapy are made with careful consideration of both potential benefits and risks.

The DIRE Score, or Diagnosis, Intractability, Risk, and Efficacy Score, is a clinical calculator used in the management of chronic pain patients who are being considered for long-term opioid therapy. This scoring system is designed to assess the patient's risk of opioid misuse and to determine the appropriateness of opioid prescription. 

The DIRE Score applies to adult patients with chronic non-cancer pain who are being evaluated for long-term opioid therapy. It is particularly useful in stratifying patients based on their risk of opioid misuse, thus aiding clinicians in making informed decisions about opioid prescription. 

The DIRE Score considers four main factors: Diagnosis (the nature and extent of the patient's pain condition), Intractability (the degree to which the pain is resistant to treatment), Risk (the patient's risk of opioid misuse or addiction), and Efficacy (the likelihood that opioid therapy will be effective for the patient's pain). 

There are no specific exclusion criteria for the use of the DIRE Score, but it should be noted that it is not intended for use in patients with cancer-related pain or in those who are already on long-term opioid therapy. It is also not a substitute for a comprehensive clinical assessment and should be used in conjunction with other clinical tools and

DIRE score for opioid prescription in chronic pain

The EULAR classification criteria for hand osteoarthritis involves a straightforward process of gathering specific patient data, evaluating this data using a scoring system, and arriving at a diagnostic interpretation based on the total score. Here's how the process works:

Inputs are gathered regarding:

- Entry criteria related to joint pain, aching, or stiffness.
- The patient's age bracket.
- Duration of morning stiffness in relevant hand joints.
- The number of joints showing osteophytes.
- The number of joints with joint space narrowing.
- Concordance between the symptoms and radiographic evidence of osteoarthritis.

Each input category is assigned a score from a predefined scale:

1. **Entry Criteria**: 
   - Symptoms present in target joints: 20 points
   - No symptoms: 0 points

2. **Age**: 
   - Below 45 years: 0 points
   - Between 45-54 years: 1 point
   - Between 55-64 years: 2 points
   - 65 years and above: 3 points

3. **Duration of Morning Stiffness**:
   - No stiffness: 1 point
   - Short duration (30 minutes or less): 2 points
   - Long duration (more than 30 minutes): 0 points

4. **Number of Joints with Osteophytes**:
   - None: 0 points
   - 1-2 joints: 2 points
   - 3-5 joints: 3 points
   - 6 or more joints: 4 points

5. **Number of Joints with Joint Space Narrowing**:
   - None: 0 points
   - 1-2 joints: 1 point
   - 3-5 joints: 2 points
   - 6 or more joints: 3 points

6. **Symptom-Structure Concordance**:
   - No concordance: 0 points
   - Yes, there is concordance: 3 points

To find the total score, add scores from each of these categories together. This cumulative score will fall somewhere between 0 and 35.

Interpretation of the score is straightforward:

- A score of 29 or higher indicates that the hand osteoarthritis diagnostic criteria are met.
- A score below 29 suggests that the diagnostic criteria are not met, potentially ruling out hand osteoarthritis.

This scoring system provides a standardized method for assessing the likelihood of hand osteoarthritis, aiding clinicians in making informed diagnostic and treatment decisions.

The European League Against Rheumatism (EULAR) classification criteria for hand osteoarthritis is a scoring system specifically designed for the classification of hand osteoarthritis in adult patients.

The clinical utility of this calculator is to aid in the diagnosis of hand osteoarthritis, a common joint disorder that often leads to pain and disability. The EULAR criteria take into account factors such as patient's age, duration of pain in the hand, number of affected joints with osteophytes and/or joint space narrowing, and symptom-structure concordance.

Exclusion criteria for the use of this calculator include the presence of other forms of arthritis such as crystal arthropathies, non-inflammatory hand conditions (such as hemochromatosis), and systemic inflammatory joint diseases (such as rheumatoid arthritis and psoriatic arthritis). Additionally, it may not be applicable in patients with recent hand trauma or surgery, as these can also cause symptoms similar to osteoarthritis.

Hand osteoarthritis

Guidelines

Key sources