DIRE score (Belgrade 2006)

DIRE

Sum Belgrade 2006 DIRE as Diagnosis + Intractability + Risk + Efficacy. Diagnosis, Intractability, and Efficacy are caller-assigned 1-3. Risk is the sum of Psychological, Chemical, Reliability, and Social support (each 1-3, so Risk 4-12). Total 7-21. Return whether the published score >= 14 cut for long-term opioid maintenance suitability is met.

LIVE $0.005 USDC GET /api/calc/dire

Markdown: /docs/dire.md · Canonical: https://magentlab.com/docs/dire

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

When to use

When an agent already has Belgrade 2006 1-3 integers for Diagnosis, Intractability, the four Risk subcategories, and Efficacy and needs the published 7-21 total and >=14 suitability cut. magent does not take a pain history, diagnose opioid use disorder, or write an opioid prescription or taper.

When not to use

Not a medical device.
Not an opioid prescription or taper order. magent does not start, stop, or dose opioids.
Each of Diagnosis, Intractability, Efficacy, and the four Risk subcategories is a caller-assigned integer 1-3. magent does not take a pain history or interview the patient.
Belgrade 2006 only. Score 14-21 more suitable for long-term opioid maintenance; 7-13 less suitable. Not a diagnosis of opioid use disorder.

Formula

DIRE = diagnosis + intractability + risk + efficacy; diagnosis, intractability, and efficacy each caller-assigned 1-3; risk = psychological + chemical + reliability + social_support (each 1-3, so risk 4-12); total 7-21; Belgrade 2006; score 14-21 more suitable for long-term opioid maintenance, 7-13 less suitable

Citation

Title: The DIRE score: predicting outcomes of opioid prescribing for chronic pain
Authors: Belgrade MJ, Schamber CD, Lindgren BR
Source: J Pain. 2006;7(9):671-681
DOI: 10.1016/j.jpain.2006.03.001

Worked example

All items 1

Given: chemical=1diagnosis=1efficacy=1intractability=1psychological=1reliability=1social_support=1

diagnosis 1 + intractability 1 + risk 4 (four subcategories at 1) + efficacy 1
Score = 7 (max 21); suitable_candidate false (7-13 less suitable)

All items 3

Given: chemical=3diagnosis=3efficacy=3intractability=3psychological=3reliability=3social_support=3

diagnosis 3 + intractability 3 + risk 12 (four subcategories at 3) + efficacy 3
Score = 21 (max 21); suitable_candidate true (14-21 more suitable). Not an opioid prescription.

Also searched as

DIRE score
DIRE
Diagnosis Intractability Risk Efficacy
Belgrade DIRE
DIRE opioid treatment
DIRE chronic pain
Belgrade 2006 DIRE score
opioid maintenance suitability
DIRE score for opioid treatment

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/dire?diagnosis=1&intractability=1&psychological=1&chemical=1&reliability=1&social_support=1&efficacy=1

Full URL: https://api.magentlab.com/api/calc/dire?diagnosis=1&intractability=1&psychological=1&chemical=1&reliability=1&social_support=1&efficacy=1

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/dire?diagnosis=1&intractability=1&psychological=1&chemical=1&reliability=1&social_support=1&efficacy=1"

Parameters

Name	Type	Required	Description
`diagnosis`	integer	required	Caller-assigned Belgrade 2006 Diagnosis (integer 1-3): 1 benign chronic condition with minimal objective findings or no definite diagnosis; 2 slowly progressive condition concordant with moderate pain, or fixed deficit; 3 advanced condition concordant with severe pain with objective findings. magent does not take a pain history.
`intractability`	integer	required	Caller-assigned Belgrade 2006 Intractability (integer 1-3): 1 few therapies tried and the patient is passively involved; 2 most appropriate treatments tried with inadequate response and the patient is reasonably involved; 3 patient fully engaged in appropriate treatments with inadequate response. magent does not take a pain history.
`psychological`	integer	required	Caller-assigned Belgrade 2006 Risk subcategory Psychological (integer 1-3): 1 serious personality dysfunction or mental illness interfering with care; 2 personality or mental health interferes moderately; 3 good psychological functioning. One of four Risk items (Risk 4-12). magent does not interview the patient.
`chemical`	integer	required	Caller-assigned Belgrade 2006 Risk subcategory Chemical (integer 1-3): 1 active or recent substance abuse; 2 chemical coper or history of chemical dependence in remission; 3 no chemical-dependence history. One of four Risk items (Risk 4-12). magent does not interview the patient.
`reliability`	integer	required	Caller-assigned Belgrade 2006 Risk subcategory Reliability (integer 1-3): 1 many missed appointments, lacks insight, or poor observer of laws and rules; 2 generally reliable; 3 highly reliable. One of four Risk items (Risk 4-12). magent does not interview the patient.
`social_support`	integer	required	Caller-assigned Belgrade 2006 Risk subcategory Social support (integer 1-3): 1 life in chaos, few resources, close relationships dysfunctional; 2 relationships exist but are strained; 3 stable supportive relationships and sufficient resources. One of four Risk items (Risk 4-12). magent does not interview the patient.
`efficacy`	integer	required	Caller-assigned Belgrade 2006 Efficacy (integer 1-3): 1 poor function or minimal pain relief despite moderate-to-high doses; 2 moderate benefit with moderate function on moderate doses; 3 good function and pain relief on stable low-to-moderate doses. magent does not take a pain history or write an opioid prescription.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/dire Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "chemical": "1",
      "diagnosis": "1",
      "efficacy": "1",
      "intractability": "1",
      "psychological": "1",
      "reliability": "1",
      "social_support": "1"
    },
    {
      "chemical": "1",
      "diagnosis": "1",
      "efficacy": "1",
      "intractability": "1",
      "psychological": "1",
      "reliability": "1",
      "social_support": "1"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/dire",
  "items": [
    {
      "reliability": 1,
      "components": [
        {
          "value": 1,
          "factor": "diagnosis",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "intractability",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "psychological",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "chemical",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "reliability",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "social_support",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "efficacy",
          "points": 1,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Belgrade MJ, Schamber CD, Lindgren BR",
        "doi": "10.1016/j.jpain.2006.03.001",
        "id": "belgrade-2006",
        "pmid": "16942953",
        "source": "J Pain. 2006;7(9):671-681",
        "title": "The DIRE score: predicting outcomes of opioid prescribing for chronic pain"
      },
      "formula": "dire",
      "formula_expression": "DIRE = diagnosis + intractability + risk + efficacy; diagnosis, intractability, and efficacy each caller-assigned 1-3; risk = psychological + chemical + reliability + social_support (each 1-3, so risk 4-12); total 7-21; Belgrade 2006; score 14-21 more suitable for long-term opioid maintenance, 7-13 less suitable",
      "max_score": 21,
      "score": 7,
      "risk": 4,
      "diagnosis": 1,
      "chemical": 1,
      "efficacy": 1,
      "intractability": 1,
      "psychological": 1,
      "social_support": 1,
      "suitable_candidate": false
    },
    {
      "reliability": 1,
      "components": [
        {
          "value": 1,
          "factor": "diagnosis",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "intractability",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "psychological",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "chemical",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "reliability",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "social_support",
          "points": 1,
          "present": true
        },
        {
          "value": 1,
          "factor": "efficacy",
          "points": 1,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Belgrade MJ, Schamber CD, Lindgren BR",
        "doi": "10.1016/j.jpain.2006.03.001",
        "id": "belgrade-2006",
        "pmid": "16942953",
        "source": "J Pain. 2006;7(9):671-681",
        "title": "The DIRE score: predicting outcomes of opioid prescribing for chronic pain"
      },
      "formula": "dire",
      "formula_expression": "DIRE = diagnosis + intractability + risk + efficacy; diagnosis, intractability, and efficacy each caller-assigned 1-3; risk = psychological + chemical + reliability + social_support (each 1-3, so risk 4-12); total 7-21; Belgrade 2006; score 14-21 more suitable for long-term opioid maintenance, 7-13 less suitable",
      "max_score": 21,
      "score": 7,
      "risk": 4,
      "diagnosis": 1,
      "chemical": 1,
      "efficacy": 1,
      "intractability": 1,
      "psychological": 1,
      "social_support": 1,
      "suitable_candidate": false
    }
  ]
}

Response

Field	Type	Description
`formula`	string	dire
`formula_expression`	string	Exact expression used
`score`	integer	Belgrade 2006 DIRE points 7-21 (Diagnosis + Intractability + Risk + Efficacy)
`max_score`	integer	Always 21
`suitable_candidate`	boolean	true iff score >= 14 (Belgrade 2006 more suitable for long-term opioid maintenance). Not an opioid prescription or taper order.
`diagnosis`	integer	Caller-assigned Diagnosis points 1-3
`intractability`	integer	Caller-assigned Intractability points 1-3
`psychological`	integer	Caller-assigned Psychological Risk points 1-3
`chemical`	integer	Caller-assigned Chemical Risk points 1-3
`reliability`	integer	Caller-assigned Reliability Risk points 1-3
`social_support`	integer	Caller-assigned Social support Risk points 1-3
`efficacy`	integer	Caller-assigned Efficacy points 1-3
`risk`	integer	Belgrade 2006 Risk 4-12: psychological + chemical + reliability + social_support
`components`	array	Per-item caller-assigned points
`citation`	object	Belgrade et al. J Pain 2006 citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "reliability": 1,
  "components": [
    {
      "value": 1,
      "factor": "diagnosis",
      "points": 1,
      "present": true
    },
    {
      "value": 1,
      "factor": "intractability",
      "points": 1,
      "present": true
    },
    {
      "value": 1,
      "factor": "psychological",
      "points": 1,
      "present": true
    },
    {
      "value": 1,
      "factor": "chemical",
      "points": 1,
      "present": true
    },
    {
      "value": 1,
      "factor": "reliability",
      "points": 1,
      "present": true
    },
    {
      "value": 1,
      "factor": "social_support",
      "points": 1,
      "present": true
    },
    {
      "value": 1,
      "factor": "efficacy",
      "points": 1,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Belgrade MJ, Schamber CD, Lindgren BR",
    "doi": "10.1016/j.jpain.2006.03.001",
    "id": "belgrade-2006",
    "pmid": "16942953",
    "source": "J Pain. 2006;7(9):671-681",
    "title": "The DIRE score: predicting outcomes of opioid prescribing for chronic pain"
  },
  "formula": "dire",
  "formula_expression": "DIRE = diagnosis + intractability + risk + efficacy; diagnosis, intractability, and efficacy each caller-assigned 1-3; risk = psychological + chemical + reliability + social_support (each 1-3, so risk 4-12); total 7-21; Belgrade 2006; score 14-21 more suitable for long-term opioid maintenance, 7-13 less suitable",
  "max_score": 21,
  "score": 7,
  "risk": 4,
  "diagnosis": 1,
  "chemical": 1,
  "efficacy": 1,
  "intractability": 1,
  "psychological": 1,
  "social_support": 1,
  "suitable_candidate": false
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_dire`	DIRE score inputs must be integers in the Belgrade 2006 published 1-3 range for diagnosis, intractability, risk subcategories, and efficacy. Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

ORT — Sum Webster 2005 Table 1 Opioid Risk Tool item weights for the assigned sex and return the published low, moderate, or high category.
Morphine milligram equivalents — Compute morphine milligram equivalents from a CDC 2022 table opioid and daily dose (or transdermal fentanyl mcg/hr).
PEG — Compute the Krebs 2009 PEG as the unweighted mean of three caller-assigned 0-10 integers (pain_average, enjoyment_of_life, general_activity). Potential range 0-10. Krebs 2009 did not publish a diagnostic cutoff.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.