often, hinting at anxiety being the root of their problems instead of pain. additionally, women are 13 to 25 percent less likely than men to receive strong "opioid" pain medication. even today women are more likely than men to be gaslit that the pain they are experiencing is all in their head. women who were emitted to the emergency room with severe stomach pain had to wait 33% longer than men with the same symptoms. females are also expected to endure more pain as a result of their biological processes, like giving birth and the effects of their menstrual cycle, in addition to the pain that comes with injury, illness, disease, that men experience aside from biological processes. the female experience of having to differentiate between normal biological pain and outside pain (illness, disease, etc.) is an experience unique to women which is why they are most often gaslit into believing the pain from injury, illness or disease comes from the processes and the pain they are expected to tolerated associated with birthing and menstrual cycles. under-representation of women in studies medical knowledge is collected through studies on biologically male bodies which raises concerns of applicability of this knowledge to biologically female bodies. historically, women have been underrepresented in clinical studies, meaning that their experience of pain and their reaction to various medications is less understood. chronic pain additionally, chronic pain, and conditions of chronic pain, are more common in women, but the rates of chronic pain and the differences in experience between men and women are not well documented. chronic pain in women may also be attributed to reproductive issues like polycystic ovary syndrome, endometriosis, menopause, dysmenorrhea, even when these are not related to the pain women are experiencing. epidemiology united states in the u.s., historical and ongoing racism against nonwhites has led to the undertreatment of pain for minorities. research review by the national academy of medicine has recorded persistent qualitative discrepancies between the medical care provided to racial minorities. in its publication unequal treatment: confronting racial and ethnic disparities in healthcare, researchers cite cultural barriers, distrust of the healthcare system by racial minorities, and racial stereotyping. in the case of cultural barriers, physicians and their patients may lack the tools to communicate effectively because of language barriers and other differences. many minority individuals may not trust their doctors due to past and current unethical medical practices, such as experiments performed on slaves, the tuskegee syphilis study, and the forced sterilization of native american women, african americans, and potentially, current immigrants in ice detention centers. they therefore avoid care or do not fully participate in treatment plans. furthermore, healthcare providers, who are typically white, may also empathize more with patients of their own race than with others. europe research conducted in europe for the journal of pain & palliative care pharmacotherapy has found that undertreatment of chronic pain in patients is widespread and is tied to legislative controls that regulate opioid prescription, which in turn creates fear of prescribing in providers. patients are also hesitant to take opioids due to fear of dependency. india a case study published in the journal of pain research revealed that in india, standardized pain management plans, which are designed to prevent pain mismanagement, are often not followed by doctors. many physicians cited fear of addiction or dependence as a reason for their hesitancy to prescribe opioids, even when indicated. in addition, they found that several other cultural factors influenced the patient's adherence to pain plans. these included fear of opioid dependence, fear of questioning authority, and the cultural belief that suffering is a part of illness and therefore should be faced with stoicism. the article also noted that similarly to the united states, several specific populations were found to have more issues with undertreatment of pain, including children, the elderly, and those with renal or hepatic dysfunction. concerns with the elderly are often due to the prevalence of multiple comorbidities that make pain difficult to manage. children often have communication barriers and neonates may be assumed not to feel pain. many drugs are activated and excreted through the liver or kidney, so when there is hepatic or renal illness, pain medication dosing needs to be adjusted in a way that isn't always standardized. latin america similar to the united states and india, fear of prescribing opioids is a main reason cited for ineffective pain management in latin america. a study in pain management notes that there is an overuse of nonopioid analgesics in latin america due to this hesitancy that can be traced back to lack of training of physicians and health care providers. other barriers to access include limited access to healthcare. undertreatment of pain is widespread due to both the lack of access to opioids, which results in moderate to severe pain being managed with non-opioid analgesics that are not as effective, and fear of prescribing opioids when available. consequences health care and pharmaceutical drugs such as pain medications are costly inadequate pain management can leave several lasting impacts on individuals, such as a decreased quality of life (qol). higher pain severity has been found to be associated with lower self-reported evaluations of mental and physical wellness, negatively affecting a wide range of qol components, including sleep, mood, mobility and physical functioning, sexual relationships, and social life. individuals with chronic pain are more likely to have psychiatric illnesses, such as depression, anxiety, and post-traumatic stress disorder. lack of postsurgical pain relief leads to higher healthcare costs as recovery time and hospital stays are prolonged. undertreatment of symptoms of pain in sickle cell patients, for instance, can give rise to millions of dollars per year directed towards more frequent emergency room visits, hospitalizations, as well as the costly effects of lost work productivity. the timely and appropriate treatment of pain, thus, can reduce economic burdens and, because pain is one of the primary reasons for hospital readmissions, significantly lower the prevalence of patients who need to return for more care. undertreated acute pain may also have more lasting physiological consequences and further contribute to healthcare spending that's avoidable. severe pain can interfere with a patient's respiratory and cardiovascular physiology with increased risks of respiratory infection, myocardial ischemia, infarct or cardiac failure, and thromboembolic disease, impeding the patient's ability to recover and be discharged. studies on patients hospitalized for issues ranging from childbirth to burn injuries to breast surgery to other serious illnesses have also all pointed to more intense acute pain levels being a risk factor for the development of chronic pain; the evidence indicates that insufficient treatment of acute pain doesn't only have temporary consequences for patients, but potentially also a decreased qol for the rest of the patient's life. acute pain, without appropriate management, can lead to chronic pain through immunological and neurological changes. prevention and screening current strategies for improvement in pain management include framing it as an ethical issue; promoting pain management as a legal right; providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right; categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies. history in 1961 the single convention on narcotic drugs established that certain drugs are "indispensible for the relief of pain and suffering" and that states should make them available to people who need them. in 2009, a who report noted that accessing treatment for pain was difficult for many people in many places in the world for a range of reasons. in 2010 the commission on narcotic drugs and adopted a resolution on access to pain treatments. also in 2010 the united nations office on drugs and crime published a feature explaining the problem of lack of access to pain treatment and expressing interest in the topic. in 2011 the international narcotics control board published a supplement to its annual report which highlighted the issue as a concern to be addressed.