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Dr Parise is assistant professor of medicine at Mid-western University/Chicago College of Osteopathic Medicine in Downers Grove, Ill.

Address correspondence to Nicholas G. Parise, DO, MS, FACOI, Diplomate, ABHPM, Director, Internal Medicine Residency Program, Swedish Covenant Hospital, 5145 N California Ave, Chicago, IL 60625. E-mail: nparise{at}schosp.org

Managing symptoms at end of life can be one of the more challenging and rewarding aspects of medical care. Pain management in particular can be made difficult from an unlikely source. Surrounded by myth, misconception, and cultural bias, opiates remain the mainstay of treatment. Frequently, patients themselves may be the most formidable barrier to their effective use. Presentation of a reality-based case serves as the basis for exploring some of these attitudes and beliefs that may be a stumbling block to opiate use in effective pain management.

The inhibiting fear associated with prescribing drugs classified as "narcotic" is illustrated through 10 common misconceptions regarding their use and is characterized by the term Opiophobia. Not all the misconceptions originate from patients, but also from family members, cultural and regulatory agency norms, and even physicians themselves. A brief discussion follows each of such flawed concepts as "morphine use indicates death is imminent," "enduring pain enhances character," hospitalization is required for effective pain management," and "opiate use always leads to addiction." Regarding the hot button issue of addiction, a glossary is provided to help in distinguishing nonaddiction etiologies that explain the frequent need for dosing increases.

The formal recognition of hospice and palliative medicine as a certified sub-specialty confirms the notion that it is the duty of physicians to provide optimal care through the dying process. Undoubtedly, evidence-based guidelines will lead to new standards of practice improving end-of-life care. This article adds perspective to past practices and opens the door to adding perspective to new ones.