ICU patients suffer from severe pain that can lead to chronic pain problems and significantly impact patients' and families' health. We analyze ICU nurses' knowledge and attitudes about pain treatment of ICU patients and identify barriers to optimal pain management in government hospitals in the West Bank, Palestine. To determine how nurses' knowledge/attitude affects other factors. The study was conducted at 12 government hospitals using cross-sectionally surveyed. The sample included 123 ICU nurses with at least six months of experience. A questionnaire from the nurses' knowledge and attitudes survey regarding pain (NKASRP) part was used to collect pain management data with a minimal test value of 0.80. Statistics were done using SPSS. Mean score: 47.8% out of 100; mean correct answers: 19.61±13.51, range: 24% to 80%. Those with pain education had significantly higher scores on knowledge and attitudes related years of work in intensive care units and previous pain education in the last 2 years (0.5048) vs. (0.4166), (p<0.05). Knowledge positively correlated with attitudes. The five least accurately answered questions were about opioid analgesic administration and physical dependence from the case study. Total barrier score: 2.399 out of 3. Demographic characteristics of nurses did not significantly affect perceived barriers. Insufficient staff understanding of pain management directly and nurses' indifference were the most perceived nurse-related barriers to effective pain treatment (n=90; 73.2%). Nurses had low pain treatment knowledge, unfavorable attitudes, and a high barrier score, indicating a pain care gap. In-service and continual pain management training are recommended for ICU nurses.