# DIRE score (Belgrade 2006) DIRE Status: LIVE Price: $0.005 USDC `GET /api/calc/dire` HTML: https://magentlab.com/docs/dire Markdown: https://magentlab.com/docs/dire.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes 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. ## 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 [The DIRE score: predicting outcomes of opioid prescribing for chronic pain](https://doi.org/10.1016/j.jpain.2006.03.001) Belgrade MJ, Schamber CD, Lindgren BR J Pain. 2006;7(9):671-681 DOI: [10.1016/j.jpain.2006.03.001](https://doi.org/10.1016/j.jpain.2006.03.001) ## Worked example ### All items 1 Given: `chemical=1, diagnosis=1, efficacy=1, intractability=1, psychological=1, reliability=1, social_support=1` 1. diagnosis 1 + intractability 1 + risk 4 (four subcategories at 1) + efficacy 1 2. Score = 7 (max 21); suitable_candidate false (7-13 less suitable) ### All items 3 Given: `chemical=3, diagnosis=3, efficacy=3, intractability=3, psychological=3, reliability=3, social_support=3` 1. diagnosis 3 + intractability 3 + risk 12 (four subcategories at 3) + efficacy 3 2. 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 ## Parameters - `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. Method: `POST /api/calc/dire` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: 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: ```json { "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" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/dire Example 200: ```json { "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 fields - `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 Frozen fixture. Not a live lookup. ```json { "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 } ``` ## Errors - HTTP 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. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [ORT](https://magentlab.com/docs/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](https://magentlab.com/docs/mme) — Compute morphine milligram equivalents from a CDC 2022 table opioid and daily dose (or transdermal fentanyl mcg/hr). - [PEG](https://magentlab.com/docs/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. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/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.