另一方面,知识不足,可怜的疼痛评估技能,消极态度和医生不愿开止痛药也被显示为一些clinician-barriers有效的疼痛管理(Cleeland,1993;·冯·Roenn等,1993)。在伊朗进行的一项研究显示,机构政策和法规,有限的时间,沟通不良,超负荷工作,强大的医生和面临的征服护理专业的机构做志愿者术后疼痛管理壁垒(Rejeh et al .,2008)。另一项研究由Rejeh et al。(2009)也描绘了护士的权力有限,病人的关系,教育准备不足和疼痛管理措施的干扰作为障碍在伊朗在术后疼痛的有效管理。
在医疗体系的一些障碍包括严格的监管审查(Cleeland et al .,1994),报销政策的变化(在这种情况下,老年患者必须支付门诊处方药品)的成本(Glajchen et al .,1995),缺乏社区药房,可怜的交通工具以及缺乏更高的剂量阿片类药物在卫生系统(Glajchen,2001)。最终,这些因素导致不恰当的止痛剂的选择及其后续管理不善的病人的痛苦(Glajchen,2001)。
On the other hand, insufficient knowledge, poor pain assessment skills, negative attitudes and physician reluctance to prescribe analgesics have also been shown as some of the clinician-barriers to effective pain management (Cleeland, 1993; Von Roenn et al, 1993). A study conducted in Iran revealed that institutional policies and regulations, limited time, poor communication, work overload, powerful physicians and the subjection faced by the nursing profession are some of the nursing-related barriers to postoperative pain management (Rejeh et al., 2008). Another study conducted by Rejeh et al. (2009) also depicted nurses’ limited authority, poor patient relationship, inadequate educational preparation and the interruptions in pain management measures serve as impediments in the effective management of postoperative pain in Iran.
Some of the barriers in the healthcare system include strict regulatory scrutiny (Cleeland et al., 1994), changes in reimbursement policies (in cases where older patients have to pay for the cost of outpatient prescription drugs) (Glajchen et al., 1995), the lack of neighbourhood pharmacies, poor means of transportation and the absence of higher doses of opioids in the health system (Glajchen, 2001). Ultimately, these factors lead to inappropriate selection of analgesics and its subsequent poor management of patients’ pain (Glajchen, 2001).