Interv Pain Med Neuromod. 2021 December; 1(1):e115716. Published online 2021 July 7. doi: 10.5812/ipmn.115716. Editorial Evolution of Interventional Pain Management and Its Barriers in Developing Countries Masoud Hashemi 1 , Reza Aminnejad 2 and Shima Rajaei 1, * 1 Shahid Beheshti Medical University, Tehran, Iran 2 Qom University of Medical Sciences, Qom, Iran * Corresponding author: Department of Anesthesiology and Pain Medicine, Shahid Beheshti Medical University, Tehran, Iran. Email: rajaei.shima@gmail.com Received 2021 May 13; Accepted 2021 May 25. Keywords: Addiction, Barriers, Economic, Burden of Disease, Developing Country, Interventional Pain Medicine The history of interventional pain management tech- niques dates back to Koller’s invention of regional anes- thesia in 1884 (1). Subsequently, regional anesthesia has developed into a distinct specialty using interventional techniques beyond simple neural blockade. In 1899, the first therapeutic nerve block in pain management was de- scribed by Tuffer (2) using spinal injection of cocaine to reduce leg sarcoma pain. Von Gaza (3) pioneered diag- nostic block using procaine to determine the pathways of pain. In the twenty-first century, interventional pain man- agement has entered the modern era with pioneers like Manchikanti et al. (4). Although interventional pain management has pro- gressed prominently, there are many inevitable differences in pain management strategies between developed and de- veloping countries. Pain is often poorly controlled in devel- oping countries (5). There are several reasons why pain of any type, is not adequately treated in these countries. The most important reasons are as follows: 1- Healthcare systems are not well developed. Pain man- agement is less of a priority than diseases such as tuber- culosis or AIDS. Low health care staff, misconceptions or outdated attitudes about pain management, insufficient knowledge about treatment choices are contributing fac- tors (6). 2- Proper pain control needs appropriate assessment. There are various tools and questionnaires for assessing pain and planning a proper pain management protocol for each patient, which need to be allocated enough time to complete. A large number of patients and limited human resources do not provide sufficient time for physicians to adequately assess and appropriately manage pain, espe- cially in chronic states (7). 3- Knowledge of caring nurses regarding pain manage- ment and adherence to established protocols are limited universally (8, 9). This shortcoming is more prevalent in developing countries. 4- Today, multidisciplinary approach to chronic pain management is a standard program to ensure good out- comes (10). Unfortunately, there are many reasons to limit this approach in developing countries. 5- In recent years, emerging drug therapies for chronic pain have been proposed and supported by communities, including the medical use of cannabis (11-13). But some cumbersome laws have prevented these new treatments from becoming common in developing countries. 6- In some cultures, pain tolerance may be seen as a sign of strength, or in labor, the presence of pain is consid- ered necessary, which are proofs of the wrong attitude of some people toward pain management (14, 15). 7- Chronic pain patients’ expectations of pain manage- ment are low or inappropriate. For example, in cancer pa- tients, most attention is paid to chemotherapy or radio- therapy, which deviates from the patient’s limited expecta- tion of his/her pain treatment (7), or patients expect to be fully cured after one or two sessions, indicating patient’s inadequate knowledge of pain management (16). 8- The range of available analgesic medications in de- veloping countries is limited, and they may not be avail- able immediately (17). Access to opioid analgesics, in par- ticular, is problematic. This is partly due to outdated and strict legal restrictions that prevent physicians from pre- scribing opioids (18, 19) Patient’s demand for these drugs is also reduced due to administrative barriers, fear of addic- tion or their high cost (20, 21). The World Health Organi- zation (WHO) estimates that 5.5 billion people (more than 80% of the world population) do not have access to treat- ments for moderate to severe pain. Most of these people Copyright © 2021, Interventional Pain Medicine and Neuromodulation. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.