Evaluation of Loma Linda University Health clinicians’ beliefs, knowledge and experiences regarding pain management

Effective pain management and safe opioid prescribing remain major challenges in healthcare delivery. Prior research demonstrates that clinicians often manage chronic pain with little or no formal training in pain management, contributing to low confidence and apprehension when prescribing opioids. Surveys also show that insufficient knowledge and inadequate preparation are among the most common barriers to adopting evidence-based opioid-prescribing practices. This study examined Clinicians’ beliefs, knowledge, and experiences regarding pain management and opioid prescribing at a large academic health system. A cross-sectional survey was administered to about 500 clinicians across multiple specialties including internal medicine, general pediatrics, surgery, family medicine and others at Loma Linda University Health (LLUH) in Spring 2018. A 54-item survey instrument developed primarily from existing medical and pharmacy education literature was used to assess clinicians’ beliefs, knowledge, and experiences related to pain management. Descriptive statistics summarized demographic and clinical characteristics. Independent t-tests and correlation analyses evaluated associations between clinicians’ beliefs, knowledge and experiences regarding pain management and opioid prescribing. Of 262 surveys returned, 255 complete responses were included for a 51% response rate. Respondents averaged 8.3 years in clinical practice and worked approximately 48 h weekly. Only 34.6% reported receiving formal pain-management training. Most clinicians (76.1%) believed opioid misuse is a major community problem, and 71.4% agreed that medical education devotes insufficient time to pain-management topics. Confidence in opioid-related counseling was low; however, fewer than half felt adequately trained or knowledgeable to manage chronic pain safely. Clinicians with formal training reported significantly higher confidence in counseling about pain, opioid use, and opioid misuse (p < 0.001). Residents were more likely than attending physicians to view their institution’s pain-management resources positively, while attendings rated their own knowledge and training more favorably. Years of clinical experience correlated positively with perceived adequacy of training (r = 0.206, p = 0.001) and knowledge (r = 0.176, p = 0,006), but negatively with perceived need for more education on opioid misuse (r=-0.241, p < 0.001). Within a single academic health system, pain management beliefs and perceived knowledge differed significantly between attending physicians and residents, underscoring the influence of training stage. Formal education emerged as a key determinant of preparedness, while persistent educational gaps highlight the need for system-level improvement. Addressing these challenges will require integrated strategies that combine targeted education, workflow-embedded supports, and institutional commitment to evidence-based, comprehensive pain care. Clinicians practicing within a university-affiliated academic health system reported substantial concern about opioid misuse alongside persistent gaps in pain management training, despite access to institutional resources. Residents and attending physicians differed in perceived preparedness: residents viewed institutional pain management resources more favorably, while attending physicians reported higher perceived knowledge and training adequacy. Formal pain management training—reported by only one-third of participants—was consistently associated with greater confidence in pain counselling, opioid prescribing, and risk communication across training stages. Prescription drug monitoring programs were widely perceived as useful, yet utilization remained inconsistent, highlighting the need for workflow-integrated system supports in addition to education. Findings suggest that targeted educational strategies, tailored by training stage and experience and paired with system-level supports, may improve clinician preparedness and opioid stewardship within academic health systems.