The United States In the U.S., historical and ongoing racism against nonwhites has led to the<unk>  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<unk>  & Palliative Care Pharmacotherapy has found that<unk>  of chronic<unk>  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<unk>  Research revealed that in India, standardized<unk>  management plans, which are designed to prevent<unk>  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<unk>  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<unk> , 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<unk>  difficult to manage. Children often have communication barriers and neonates may be assumed not to feel<unk> . Many drugs are activated and excreted through the liver or kidney, so when there is hepatic or renal illness,<unk>  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<unk>  management in Latin America. A study in<unk>  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.<unk>  is widespread due to both the lack of access to opioids, which results in moderate to severe<unk>  being managed with non-opioid analgesics that are not as effective, and fear of prescribing opioids when available.
Undertreatment of pain
Financial toxicity
Futile medical care
Chiropractic controversy and criticism
Prescription drug addiction
Noxious stimulus
Antibiotic use in dentistry
Distress in cancer caregiving