Discussion This study compared the use of morphine as perceived by GP and HP in the region of Beira Interior in North-Eastern Portugal. There are differences of perception but also common fears. It might well induce some reluctance regarding the use of morphine. This in turn might influence negatively patient care in general and pain management more specifically. Most studies reporting “false beliefs” regarding the use of morphine in pain management

focus either on specific ethnics groups or on health professionals [13,4,29-31]. Studies comparing GP and HP in this field are few. One done by Musi et al. [26] in Northern Italy confirms our results. These authors mention than 39% of Inhibitors,research,lifescience,medical GP primarily associate the word morphine with

«drugs» and «the risks of somnolence, dependency and the seriousness of the clinical situation». Other studies also support our observations. Weisse et al. [31] report that the physicians’ attitude in prescribing analgesics for pain management Inhibitors,research,lifescience,medical varies according sex and ethnic group. Bernades [32] reports a difference in perception of pain according to sex. Riley et al. [29,33] and Robinson et al. [30] show a significant difference in chronic pain management according to age. In our study morphinofobia among HP seems related to false beliefs on side effects Inhibitors,research,lifescience,medical of morphine, risks of addiction and legal constraints in the prescription of morphine. Yet the word morphine is principally associated with the notion of analgesia. Musi et al. [26] reports in his study among HP that the word morphine is associated first with « pain » followed by «analgesia, drug, cancer, death and sedation» which does not differ much from our observations. Other authors report Inhibitors,research,lifescience,medical similar data to ours. Seddon et al. [34] mention clearly that the use of morphine in pain management is strongly influenced by the society’s perceptions, Inhibitors,research,lifescience,medical especially as far as addiction and the legal constrains go. The recent CI-1033 in vivo Italian

study of Bandieri et al. [13] analysed the consumption of opioids between 2000 and 2008 and showed an increase in the use of opioids in general, but a decrease use of oral morphine. The conclusions of the authors are clear: the behaviour of physicians is still largely contrary to guidelines, suggesting that either cultural or marketing rather than legal nearly factors are mainly responsible for morphinofobia. Staton [35] reports a significant difference in the perception of pain between physicians and patients, especially among certain ethnic groups (Afro-Americans). Nishimori [36] studying opiates abuse among patients at home reported treatment failure by physician in case of opioïde dependency. Ballantyne et al. [37] in a review of literature on chronic pain treatment with opioïdes shows discrimination in prescribing morphine in relation with fears of dependencies.