Skip to main content
SpringerLink
Log in

Opiophobie: état des lieux auprès des soignants à Beira Interior au Portugal

Opiophobia: the situation amongst health professionals in Beira Interior, Portugal

  • Article Original / Original Article
  • Published:
Douleur et Analgésie

Résumé

Contexte

L’opiophobie de certains professionnels de santé n’est pas anodine: elle peut entraîner une prise en charge inappropriée des patients présentant des douleurs invalidantes.

Objectifs

Cette étude avait pour objectifs de comparer l’opiophobie entre médecins et infirmières d’une part; et d’autre part de décrire les représentations que ces professionnels de santé ont de la morphine et leur attitude face à sa prescription et à son utilisation ainsi que les raisons évoquées.

Méthode

Enquête par questionnaire autoadministré auprès des médecins et infirmières des hôpitaux et centres médicosociaux à Beira Interior au Portugal.

Résultats

Le mot morphine évoque en premier lieu l’analgésie (médecins 32 % et infirmières 27 %) et en deuxième lieu le cancer (médecins 12 % et infirmières 27 %). L’attitude en ce qui concerne le recours à la morphine diffère entre médecins et infirmières, notamment en fonction de l’expérience professionnelle. Les raisons les plus fréquemment évoquées de non-administration de la morphine chez le patient algique sont les difficultés légales d’usage (médecins 79 % et infirmières 84 %), le risque de dépression respiratoire (médecins 70 % et infirmières 68 %) et le risque de dépendance (médecins 50 % et infirmières 69 %).

Conclusion

L’existence de fausses croyances quant à la prescription et l’utilisation de la morphine dans notre collectif. Une différence significative existe pour plusieurs fausses croyances relatives à la prescription et à l’utilisation de la morphine entre infirmières et médecins. Ces résultats suggèrent que l’on forme mieux les professionnels de santé dans la gestion de la douleur.

Abstract

Context

Opiophobia in health care professionals is not without danger for patients: it may lead to the inappropriate management of debilitating pain.

Objectives

To describe and compare how nurses and physicians perceive morphine, and their attitudes to prescribing and administering it.

Methods

A cross-sectional study of physicians and nurses in Beira Interior (Portugal), through a self-administered questionnaire.

Results

The word morphine firstly recalls analgesia (physicians 32% and nurses 27%); secondly it is associated with the word “cancer” (physicians 12% and nurses 27%). Attitudes towards the use of morphine show significant variations among physicians and nurses, depending on their professional experience. The reasons for not administrating morphine most frequently cited are: legal problems (physicians 79% and nurses 84%), the risk of respiratory depression (physicians 70% and nurses 68%) and the risk of dependency (physicians 50% and nurses 69%).

Conclusion

There are significantly differing attitudes and beliefs concerning the prescription and use of morphine amongst nurses and physicians. Opiophobia exists in both nurses and physicians. Better training of health professionals with regard to the prescription and use of morphine is required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. American Pain Society (1992) Principles of analgesic use in the treatment of acute pain and chronic cancer pain: a concise guide to medical practice, 3rd ed. American Pain Society, Skokie

    Google Scholar 

  2. Andersen S, Leikersfeldt G (1996) Management of chronic nonmalignant pain. Br J Clin Pract 50:324–330

    PubMed  CAS  Google Scholar 

  3. Anthelme J (2004) Au cœur de la souffrance, histoire de la morphine. Forum de la douleur, pp. 1–2

  4. Ballantyne JC (2006) Opioids for chronic pain: taking stock. Pain 125:3–4

    Article  PubMed  Google Scholar 

  5. Carvalho ML (2005) Especialista em medecina general e familiar. Conhecimentos e atitudes dos médicos em relação ao controlo da dor. Mestrado em Cuidados Paliativos, 179 pages, Faculdade de medecina de Lisboa

  6. Correia D, Silva R, Filipe L, et al (1999) The use of opioids in oncologic in Madeira island: mythes and difficulties. Sitio web de la sociedad española del dolor (SED 1999. IV Congreso de la Sociedad del dolor (Malaga)

  7. Covington EC (2000) Opiophobia, Opiophilia, Opioagnosia. Pain Med 1(3):217–223

    Article  PubMed  CAS  Google Scholar 

  8. Devi BC, Tang TS, Corbex M (2006) What doctors know about cancer pain management: an exploratory study in Sarawak, Malaysia. J Pain Palliat Care Pharmacother 20(2):15–22

    Article  PubMed  Google Scholar 

  9. Dion D, Choinière M (2004) Dépendance et tolérance aux opiacés: des enjeux importants en clinique ? Anesthésiologie conférences scientifiques 3:1

    Google Scholar 

  10. Direcção Geral da Saúde (2003) Circular normativa no 9/DGCG Lisboa. A Dor como 5° sinal Vital. Registo sistematico da Intensidade da Dor. Ministério da Saude, pp. 1–4

  11. Dobscha SK, Corson K, Flores JA, et al (2008) Veterans affaires primary care clinicians’ attitudes toward chronic pain and correlates of opioid prescribing rates. Pain Med 9:564–571

    Article  PubMed  Google Scholar 

  12. Edwards HE, Nash RE, Najman JM, et al (2001) Determinants of nurses’ intention to administrer opioids for pain relief. Nurs Health Sci 3:149–159

    Article  PubMed  CAS  Google Scholar 

  13. Elliott TE, Elliot BA (1992) Physician attitudes and beliefs about use of morphine for cancer pain. J Pain Symptom Manage 7(3): 141–148

    Article  PubMed  CAS  Google Scholar 

  14. Foley KM (1995) Misconceptions and controversies regarding the use of opioids in cancer pain. Anticancer Drugs 6:4–13

    Article  PubMed  CAS  Google Scholar 

  15. Gallagher J, O’Gara C, Sessay M, Luty J (2006) Nurse prescribing in addiction services: client benefits. Nurs Stand 20:42–44

    PubMed  Google Scholar 

  16. Gerbershagen K, Gerbershagen HU, Lindena GU, et al (2008) Prevalence and impact of pain in neurological inpatients of a German teaching hospital. Clin Neurol Neurosurg 110:710–717

    Article  PubMed  Google Scholar 

  17. Ger LP, Ho ST, Wang JJ (2000) Physicians’ knowledge and attitudes toward the use of analgesics for cancer pain management: a survey of two medical centers in Taiwan. J Pain Symptom Manage 20:335–344

    Article  PubMed  CAS  Google Scholar 

  18. Gilson AM, Maurer MA, Joranson DE (2007) State medical board members’ beliefs about pain, addiction, and diversion and abuse: a changing regulatory environment. J Pain 8:682–691

    Article  PubMed  Google Scholar 

  19. Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J (2008) Healthcare professionals’ intentions and behaviors: a systematic review of studies based on social cognitive theories. BMC Implement Sci 3:36

    Article  Google Scholar 

  20. Grossman SA (1993) Undertreatment of pain: barriers and remedies. Support Care Cancer 1(2):74–78

    Article  PubMed  CAS  Google Scholar 

  21. Hanks GW, de Conno F, Cherny N, et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84:587–593

    Article  PubMed  CAS  Google Scholar 

  22. Heins JK, Heins A, Grammas M, et al (2006) Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. J Emerg Nurs Jun 32(3):219–224

    Article  Google Scholar 

  23. Hill CS Jr (1993) The barriers to adequate pain management with opioid analgesics. Semin Oncol 20(2):1–5

    PubMed  Google Scholar 

  24. Jacobsen R, Sjøgren P, Møldrup C, Christrup L (2007) Physicianrelated barriers to cancer pain management with opioid analgesics: a systematic review. J Opioid Manag 3:207–214

    PubMed  Google Scholar 

  25. Lander J (1990) Fallacies and phobias about addiction and pain. Br J Addict 85:803–809

    Article  PubMed  CAS  Google Scholar 

  26. Larue F, Colleau SM, Fontaine A, Brasseur L (1995) Oncologists and primary care physicians’ attitudes toward pain control and morphine prescribing in France. Cancer 76:2375–2382

    Article  PubMed  CAS  Google Scholar 

  27. Maxwell CJ, Dalby DM, Slater M, et al (2008) The prevalence and management of current daily pain among older home care clients. Pain 138:208–216

    Article  PubMed  Google Scholar 

  28. McCaffery M, Ferrell BR (1999) Opioids and pain management: what do nurses know? Nursing 29(3):48–52

    PubMed  CAS  Google Scholar 

  29. Melotti RM, Samolsky-Dekel BG, Ricchi E, et al (2005) Pain prevalence and predictors among inpatients in a major Italian teaching hospital. A baseline survey towards a pain free hospital. Eur J Pain 9:485–495

    Article  PubMed  Google Scholar 

  30. Merrill JM, Dale A, Thornby JI (2000) Thanatophobia and opiophobia of hospice nurses compared with that of other caregivers. Am J Hosp Palliat Care 17(1):15–23

    Article  PubMed  CAS  Google Scholar 

  31. Musi M (1999) Douleur n’est pas souffrance. Le refus de traitement de la douleur cancéreuse. Mémoire. Master européen soins palliatifs et thanatologie, institut universitaire K Bösch, Sion (CH) 155 pages

    Google Scholar 

  32. Musi M, Bionaz A (2003) Les mythes de la morphine. Une étude auprès de la population générale, des infirmiers/ères et des médecins en Vallée d’Aoste, Infokara, pp. 1–18

    Google Scholar 

  33. Nwokeji ED, Rascati KL, Brown CM, Eisenberg A (2007) Influences of attitudes on family physicians willingness to prescribe long-acting opioid analgesics for patients with chronic non-malignant pain. Clin Ther 29:2589–2602

    Article  PubMed  Google Scholar 

  34. Ripamonti C, De Conno F, Blumhuber H, Ventafridda V (1996) Morphine for relief of cancer pain. Lancet 347:1262–1263

    Article  PubMed  CAS  Google Scholar 

  35. Salomon L, Tcherny-Lessenot S, Collin E, et al (2002) Pain prevalence in a French teaching hospital. J Pain Symptom Manage 24(6):586–592

    Article  PubMed  Google Scholar 

  36. Strohbuecker B, Mayer H, Evers GC, Sabatowski R (2005) Pain prevalence in hospitalized patients in a German university teaching hospital. J Pain Symptom Manage 29(5):498–506

    Article  PubMed  Google Scholar 

  37. Strumpf M, Köhler A, Zenz M, et al(1997) Opioide und Fahrtüchtigkeit. Schmerz 11:233–240

    Article  PubMed  CAS  Google Scholar 

  38. Tamchès E, Buclin T, Hugli O, et al (2007) Acute pain in adults admitted to the emergency room: development and implementation of abbreviated guidelines. Swiss Med Wkly 137:223–227

    PubMed  Google Scholar 

  39. Tennant F (2007) Overcoming opiophobia and doing opioids right. Pain treatment topics. www.pain-topics.org, mai 2007

  40. Trescot AM, Glaser SE, Hansen H, et al (2008) Effectiveness of opioids in the treatment of chronic non-cancer pain. Pain Physician 11:181–200

    Google Scholar 

  41. Trescot AM, Helm S, Hansen H, et al (2008) Opioids in the management of chronic non-cancer pain: an update of American Society of the International Pain Physicians (ASIPP) guidelines. Pain Physician 11:5–62

    Google Scholar 

  42. Turk DC, Brody MC, Okifuji EA (1994) Physicians attitudes and practices regarding the long-term prescribing of opioids for non-cancer pain. Pain 59:201–208

    Article  PubMed  CAS  Google Scholar 

  43. Yun YH, Park SM, Lee K, et al (2005) Predictors of prescription of morphine for severe cancer pain by physicians in Korea. Ann Oncol 16:966–971

    Article  PubMed  CAS  Google Scholar 

  44. Von Roenn JH, Cleeland CS, Gonin R, et al (1993) Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. Ann Intern Med 119:121–126

    Google Scholar 

  45. Weinstein SM, Laux LF, Thornby JI, et al (2000) Physicians’ attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas cancer pain initiative. South Med J 93:479–487

    PubMed  CAS  Google Scholar 

  46. Withe ID, Hoskin PJ, Hanks GW, Bliss JM (1991) Analgesics in cancer pain: current practice and belief. Br J Cancer 63:271–274

    Google Scholar 

  47. World Health Organization (1996) Freedom from cancer pain. World Health Organization, Geneva

    Google Scholar 

  48. Zacny JP, Lichtor SA (2008) Non-medical use of prescription opioids: motive and ubiquity issues. J Pain 9:473–486

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinique genevoise de Montana, impasse Clairmont-II, CH-3963, Montana, Suisse

    H. Verloo

  2. Département de médecine et santé communautaires, faculté de médecine, université de Genève et école suisse de santé publique, Zurich. IMSP-CMU, Michel Servet1, 1211, Genève 4, Suisse

    E. Mpinga Kabengele

  3. Unité de chirurgie, hôpital régional de Sierre, RSV, Valais, 14, rue Saint-Charles, CH-3960, Sierre, Suisse

    M. Ferreira

  4. Département de médecine et de santé communautaire-âges, santé et société faculté de médecine, institut universitaire Kurt-Bösch, case postale 4176, CH-1950, Sion 4, Suisse

    C. -H. Rapin

  5. Département de médecine et de santé communautaire, faculté de médecine, université de Genève, 40, boulevard du Pont-d’Arve, CH-1211, Genève 4, Suisse

    P. Chastonay

Authors
  1. H. Verloo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Mpinga Kabengele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. -H. Rapin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Chastonay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Verloo.

Additional information

En mémoire du Pr Charles-Henri Rapin, décédé le 10 juillet 2008 à Sion

About this article

Cite this article

Verloo, H., Mpinga Kabengele, E., Ferreira, M. et al. Opiophobie: état des lieux auprès des soignants à Beira Interior au Portugal. Douleur analg 22, 186–195 (2009). https://doi.org/10.1007/s11724-009-0134-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11724-009-0134-7

Mots clés

Keywords

Search

Navigation