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| Toronto | Kuwait | Karachi |
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| 2(a) Infrastructure |
| (i) Psychological and social support services | 3.25 | 3.75 | 3.75 |
| (ii) Lack of access to interventions (blocks, spinal stimulators, etc.) | 2.25 | 2.25 | 2.75 |
| (iii) Lack of time and resources to address noncancer pain | 3 | 3.25 | 2.75 |
| (iv) Access to assessment of patients with CNCP | 1.5 | 1.5 | 2.75 |
| (v) Clinic too far or inconvenient for patients’ to travel to | 3 | 1.75 | 3.25 |
| (vi) High cost of medications and treatments | 3 | 0.75 | 4 |
| (vii) Lack of access to wide range neuropathic adjuvant medications (e.g., gabapentin, pregabalin, duloxetine) | 2.25 | 1.5 | 1.75 |
| (viii) Access to wide range of opioids | 1 | 3 | 3 |
| (ix) Regulation of opioids by Narcotics Bureau, Dept. of Health | 0 | 3.25 | 3.25 |
| (x) Excessive regulation of opioids in pharmacy | 0 | 3 | 3.5 |
| (xi) Waiting list to see physicians/specialists | 3 | 2.5 | 2.75 |
| (xii) Regulatory barriers to effective pain management | 1.5 | 2.75 | 2.75 |
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| 2(b) Clinical Services/Practices |
| (i) Coordination of care, particularly acute to chronic transition | 3.25 | 3.5 | 3 |
| (ii) Patient and family fear that reporting pain will exclude a patient from clinical trials or treatment | 1 | 1.5 | 2 |
| (iii) Patients’ reluctance to take opioids | 2 | 2.25 | 3 |
| (iv) Legal and regulatory sanctions for opioid use | 0.5 | 2 | 3.5 |
| (v) Inadequate reimbursement for providers | 1.75 | 0.5 | 2.25 |
| (vi) Patient and family failure to mention pain to providers | 1 | 1 | 2.5 |
| (vii) Religion (e.g., male physicians cannot see female patients, etc.) | 1 | 0.5 | 2.5 |
| (viii) Cultural barriers to accepting taking pain medications | 1 | 2 | 2.5 |
| (ix) Cultural barriers (e.g., male patients do not complain as they think pain is a sign of weakness) | 1 | 1.25 | 2.25 |
| (x) Physicians’ reluctance to prescribe opioids | 0.5 | 3.75 | 3 |
| (xi) Patient’s fear drugs will lose their effectiveness | 2.25 | 3.25 | 3 |
| (xii) Patient adherence to treatment regimens | 2.75 | 3.25 | 3 |
| (xiii) Lack of public awareness about the presence of pain clinic | 2.25 | 3.5 | 3.75 |
| (xiv) Cognitive impairment hindering assessment | 1.75 | 2 | 2.5 |
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| 2(c) Education |
| (i) Inadequate CNCP management training and education of staff | 3 | 1 | 3 |
| (ii) A priority on curing noncancer pain over managing | 3.75 | 2.25 | 3 |
| (iii) Knowledge about available resources | 2.5 | 3.25 | 3 |
| (iv) Awareness of other physicians about pain clinic benefits for referral purposes | 1.75 | 3.5 | 3.75 |
| (v) Inadequate staff knowledge of pain management | 2 | 3.25 | 3.25 |
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