Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?


  • Jean C. McCalmont, DNP, FNP
  • Kim D. Jones, PhD, FNP, FAAN
  • Robert M. Bennett, MD, FRCP, MACR
  • Ronald Friend, PhD



chronic pain, 2016 CDC guideline, opioid prescribing, provider practice


Objectives: (1) To assess providers’ experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers’ utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations.

Methods: A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (11) hours of training. Results: The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers’ profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9).

Conclusions: Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.

Author Biographies

Jean C. McCalmont, DNP, FNP

Nursing, Oregon Health & Science University, Portland, Oregon

Kim D. Jones, PhD, FNP, FAAN

Nursing, Oregon Health & Science University, Portland, Oregon

Robert M. Bennett, MD, FRCP, MACR

Nursing, Oregon Health & Science University, Portland, Oregon

Ronald Friend, PhD

Psychology, Stony Brook University, Stony Brook, New York


Gureje O, Von Korff M, Simon GE, et al.: Persistent pain and well-being: A World Health Organization study in primary care. JAMA. 1998; 280(2): 147-151.

Rasu RS, Sohraby R, Cunningham L, et al.: Assessing chronic pain treatment practices and evaluating adherence to chronic pain clinical guidelines in outpatient practices in the United States. J Pain. 2013; 14(6): 568-578.

Jamison RN, Scanlan E, Matthews ML, et al.: Attitudes of primary care practitioners in managing chronic pain patients prescribed opioids for pain: A prospective longitudinal controlled trial. Pain Med. 2014; 17: 99-113.

Mezei L, Murinson BB: Pain education in North American medical schools. J Pain. 2011; 12(12): 1199-1208.

Canada RE, DiRocco D, Day S: A better approach to opioid prescribing in primary care. J Family Pract. 2014; 63(6): E1-E8.

Keller CE, Ashrafioun L, Neumann AM, et al.: Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain. Subst Abuse. 2012; 33(2): 103-113.

Allen MJ, Asbridge MM, Macdougall PC, et al.: Self-reported practices in opioid management of chronic noncancer pain: A survey of Canadian family physicians. Pain Res Manag. 2013; 18(4): 177-184.

Potter M, Schafer S, Gonzalez-Mendez E, et al.: Opioids for chronic nonmalignant pain. Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. University of California, San Francisco. J Fam Pract. 2001; 50(2): 145-151.

Green CR, Wheeler J, LaPorte F, et al.: How well is chronic pain managed? Who does it well? Pain Med. 2002; 3: 56–65.

Centers for Disease Control and Prevention: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. Available at Published March 18, 2016. Accessed September 2, 2016.

Pergolizzi JV, Raffa RB, LeQuang JA: The Centers for Disease Control and Prevention opioid guidelines: Potential for unintended consequences and will they be abused? J Clin Pharm Ther. 2016; 41:592-593.

Bero LA, Grilli R, Grimshaw JM, et al.: Getting research findings into practice: Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998; 317(7156): 465–468.

Fudin J, Raouf M, Wegrzyn EL: Opioid dosing policy: Pharmacological considerations regarding equianalgesic dosing. Available at Accessed October 8, 2017.

Hollingshead NA, Meints S, Middleton SK, et al.: Examining influential factors in providers' chronic pain treatment decisions: A comparison of physicians and medical students. BMC Med Educ. 2015; 15(164): 1-8.

Hutchinson K, Moreland A, de Williams A, et al.: Exploring beliefs and practice of opioids prescribing for persistent noncancer pain by general practitioners. Eur J Pain. 2007; 11: 93-98.

Schneider JP: CDC recommendations fall short and ignore important aspects of pain management. Pract Pain Manage. 2016; 16(3): 18-21.

Morse JS, Stockbridge H, Egan KB, et al.: Primary care survey of the value and effectiveness of the Washington State Opioid Dosing Guideline. J Opioid Manag. 2011; 7(6): 427-433. Continuing education. Available at Accessed April 4, 2017.

Hooten WM, Bruce BK: Beliefs and attitudes about prescribing opioids among healthcare providers seeking continuing medical education. J Opioid Manag. 2011; 7(6): 417-424.

Lalonde L, Leroux-Lapointe V, Choiniere, M, et al: Knowledge, attitudes and beliefs about chronic noncancer pain in primary care: A Canadian survey of physicians and pharmacists. Pain ResManag. 2014; 19(5): 241-250.

Kavukcu E, Akdeniz M, Huseyin H, et al.: Chronic non-cancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse. Postgrad Med. 2015; 127(1): 22-26.

Regunath H, Cochran K, Cornell K, et al.: Is it painful to manage chronic pain? A cross-sectional study of physicians in-training in a university program. Missouri Med. 2016; 113(1): 72-78.

McCracken LM, Velleman SC, Eccleston C: Patterns of prescription and concerns about opioid analgesics for chronic non-malignant pain in general practice. Primary Health Care Res Dev. 2012; 9: 146-156.

Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse: Pain Management and the Opioid Epidemic. Washington, DC: The National Academies Press, 2017: 1-14.

Creech CJ, Clark S, Grube G, et al.: Nurse practitioner management of chronic musculoskeletal pain: A chart review. Nurse Pract. 2011; 36(9): 29-36.

National Center for Health Statistics: Healthy people 2010 final review. Available at Accessed September 7, 2016.

Council of State Governments: Health care workforce shortages critical in rural America, CAPITOL facts & figures. Available at Accessed April 2, 2017.

Gamm L, Hutchison, L, Bellamy G, et al.: Rural healthy people 2010: Identifying rural health priorities and models for practice. J Rural Health. 2002; 18(1): 9-14.

Remster EN, Marx TL: Barriers to managing chronic pain: A pilot of prescriber perceptions in rural Appalachia. J Pain Symptom Manag. 2008; 36(3): e1-e2.

Oregon Health Authority: Oregon opioid prescribing guidelines: Recommendations for the safe use of opioid medications. Available at Accessed February 16, 2017.

Centers for Disease Control and Prevention: CDC Guideline for Prescribing Opioids for Chronic Pain. Available at

Accessed October 8, 2017.




How to Cite

McCalmont, DNP, FNP, J. C., K. D. Jones, PhD, FNP, FAAN, R. M. Bennett, MD, FRCP, MACR, and R. Friend, PhD. “Does Familiarity With CDC Guidelines, Continuing Education, and Provider Characteristics Influence Adherence to Chronic Pain Management Practices and Opioid Prescribing?”. Journal of Opioid Management, vol. 14, no. 2, Mar. 2018, pp. 103-16, doi:10.5055/jom.2018.0437.