Table 1.

Barriers to the optimal treatment of pain in developing countries (15).

Structural and knowledge barriers	Socio-cultural and attitude barriers	Economic barriers
• Pain is not recognized as a public health priority •General Practitioners do not have the required knowledge and expertise to treat pain •There is a scarcity of qualified pain specialists •Many schools of medicine and of pharmacy have very limited time included in their curricula for the treatment of pain •Resources and medical personnel are unevenly distributed •Administrative requirements to access pain medications are significant and deter usage •Regulation of pain medication may be restrictive at a country level due to fears of misuse, abuse and diversion	• Cultural beliefs impact the understanding and treatment of pain •Many accept pain as a natural and unavoidable part of aging and disease •Traditional medicines are the preferred treatment in some countries •Religious beliefs in some countries see pain as a part of atonement and this leads to reduced help-seeking behavior and treatment •Patients, healthcare workers and governments may have a fear of using opioids for treatment	• Competing demands for resources at a country level impact negatively on healthcare spending in general, and on the treatment of pain specifically •The cost of medicines and other treatments could be high or not seen as priority •Vulnerable sub-groups and people with lower socio-economic status have less access to resources to seek and pay for treatment