Development and Implementation of an Online Pain Management Continuing Education Program



      Multiple studies indicate a lack of pain management training across a range of healthcare specialties. The online Joint Pain Education Program (OJPEP) was created to provide content covering various topics that range from general pain science to integrative care to pain management. The present study evaluates the feasibility of an interdisciplinary, self-guided, online pain management continuing education program, the OJPEP.


      A total of 228 learners participted in this study. Of the 228 learners, 58 learners identified as registered nurses and 12 learners identified as nurse practitioners.


      Prospective single-arm education feasibility study.


      Potential learners were provided invitations to participate via emails from clinic leadership and postings to hospital intranet websites. Learners registered online and could select up to eight modules, based on the materials developed from a Department of Defense/Veterans Administration project. Learners evaluated their satisfaction with module quality and applicability.


      A variety of providers, predominately non-prescribers, across many health care specialties, registered for modules. Across all modules except one, less than half of participants who registered completed the selected module. Time stamps indicated many learners skipped module content. Of those who completed the continuing education evaluation to obtain certificates, the majority indicated the content was of high-quality, appropriate, and evidence-based. One-third to approximately one-half of learners indicated that they would apply content in their clinical practice. Completion of the intended 3-month follow-up survey was poor.


      Though modules were acceptable per learner responses, future work is needed to: develop modules that are more engaging (e.g., interactive) and applicable to learners; and improve implementation methods to include dissemination and evaluation metrics.
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        • Arkin L.C.
        • Lyons M.T.
        • McNaughton M.A.
        • Quinlan-Colwell A.
        Position statement: Acute perioperative pain management among patients undergoing orthopedic surgery by the American Society for Pain Management Nursing and The National Association of Orthopaedic Nurses.
        Pain Management Nursing. 2022;
        • Bowen D.J.
        • Kreuter M.
        • Spring B.
        • Cofta-Woerpel L.
        • Linnan L.
        • Weiner D.
        • Bakken S.
        • Kaplan C.P.
        • Squiers L.
        • Fabrizio C.
        • Fernandez M.
        How we design feasibility studies.
        American Journal of Preventative Medicine. 2009; 36: 452-457
        • Burgess G.
        • Jensen L.E.
        Occupational therapy for adults with brain tumors in the acute care setting.
        NeuroRehabilitation. 2019; 45: 151-161
      1. Centers for Disease Control and Prevention (CDC). (2019a). Annual surveillance report of drug-related risks and outcomes — United States surveillance special report. Retrieved Oct 12. 2020, from

        • Centers for Disease Control and Prevention (CDC)
        CDC advises against misapplication of the Guideline for Prescribing Opioids for Chronic Pain.
        2019 (Retrieved Mont Oct 12. 2020, from)
        • Chiu A.S.
        • Ahle S.L.
        • Freedman-Weiss M.R.
        • Yoo P.S.
        • Pei K.Y.
        The impact of a curriculum on postoperative opioid prescribing for novice surgical trainees.
        American Journal of Surgery. 2019; 217: 228-232
        • Chow K.M.
        • Chan J.C.Y.
        Pain knowledge and attitudes of nursing students: A literature review.
        Nurse Education Today. 2015; 35: 366-372
        • Cleland J.A.
        • Fritz J.M.
        • Brennan G.P.
        • Magel J.
        Does continuing education improve physical therapists' effectiveness in treating neck pain? A randomized clinical trial.
        Physical Therapy. 2009; 89: 38-47
        • Cook D.A.
        • Blachman M.J.
        • Price D.W.
        • West C.P.
        • Berger R.A.
        • Wittich C.M.
        Professional development perceptions and practices among U.S. physicians: A cross-specialty national survey.
        Academic Medicine. 2017; 92: 1335-1345
        • Cui J.
        • Zhou L.
        • Zhang L.
        • Li L.
        • Zhao J.
        Training the trainer: An educational course for training pain nursing specialists supported by the International Association for the Study of Pain (IASP).
        Pain Management Nursing. 2013; 14: e142-e150
        • Darnall B.D.
        • Carr D.B.
        • Schatman M.E.
        Pain psychology and the biopsychosocial model of pain treatment: Ethical imperatives and social responsibility.
        Pain Medicine (Malden, Mass.). 2017; 18: 1413-1415
        • Davis C.S.
        • Lieberman A.J.
        Laws limiting prescribing and dispensing of opioids in the United States, 1989-2019.
        Addiction. 2021; 116: 1817-1827
        • Drake G.
        • de C Williams A.C.
        Nursing education interventions for managing acute pain in hospital settings: A systematic review of clinical outcomes and teaching methods.
        Pain Management Nursing. 2017; 18: 3-15
        • Duensing K.
        • Twillman R.
        • Ziegler S.
        • Cepeda M.S.
        • Kern D.
        • Salas M.
        • Wedin G.
        An examination of state and federal opioid analgesic and continuing education policies: 2016-2018.
        Journal of Pain Research. 2020; 13: 2431-2442
        • Ezenwa M.O.
        • Fleming M.F.
        Racial disparities in pain management in primary care.
        Journal of Health Disparities Research and Practice. 2012; 5: 12-26
        • Fang L.
        • Chen L.
        • Sun H.
        • Xu Y.
        • Jin J.
        The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center, Controlled before-after Study in China.
        Pain Management Nursing. 2021; 22: 198-204
        • Flynn D.M.
        • Eaton L.H.
        • McQuinn H.
        • Alden A.
        • Meins A.R.
        • Rue T.
        • Tauben D.J.
        • Doorenbos A.Z.
        TelePain: Primary care chronic pain management through weekly didactic and case-based telementoring.
        Contemporary Clinical Trials Communications. 2017; 8: 162-166
        • Forsetlund L.
        • O'Brien M.A.
        • Forsén L.
        • Reinar L.M.
        • Okwen M.P.
        • Horsley T.
        • Rose C.J.
        Continuing education meetings and workshops: Effects on professional practice and healthcare outcomes.
        Cochrane Database of Systematic Reviews. 2021; 9CD003030
        • Frogner B.K.
        • Harwood K.
        • Andrilla C.H.A.
        • Schwartz M.
        • Pines J.M.
        Physical therapy as the first point of care to treat low back pain: An instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs.
        Health Services Research. 2018; 53: 4629-4646
        • Furlan A.D.
        • Zhao J.
        • Voth J.
        • Hassan S.
        • Dubin R.
        • Stinson J.N.
        • Jaglal S.
        • Fabico R.
        • Smith A.J.
        • Taenzer P.
        • Flannery J.F.
        Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas.
        Journal of Telemedicine and Telecare. 2019; 25: 484-492
        • Garcia J.
        • Ohanisian L.
        • Sidley A.
        • Ferris A.
        • Luck G.
        • Basich G.
        • Garcia A.
        Resident knowledge and perception of pain management.
        Cureus. 2019; 11: e6107
        • Giguère A.
        • Zomahoun H.T.V.
        • Carmichael P.H.
        • Uwizeye C.B.
        • Légaré F.
        • Grimshaw J.M.
        • Gagnon M.P.
        • Auguste D.U.
        • Massougbodji J.
        Printed educational materials: effects on professional practice and healthcare outcomes.
        Cochrane Database of Systematic Reviews. 2020; 8CD004398
        • Hoffman K.M.
        • Trawalter S.
        • Axt J.R.
        • Oliver M.N.
        Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.
        Proceedings of the National Academy of Sciences of the United States of America. 2016; 113: 4296-4301
        • Knopf A.
        CDC proposes new guideline for opioid pain prescribing.
        Alcoholism & Drug Abuse Weekly. 2022; 34: 6-7
        • Lewthwaite B.J.
        • Jabusch K.M.
        • Wheeler B.J.
        • Schnell-Hoehn K.N.
        • Mills J.
        • Estrella-Holder E.
        • Fedorowicz A.
        Nurses' knowledge and attitudes regarding pain management in hospitalized adults.
        Journal of Continuing Education in Nursing. 2011; 42 (quiz 258-259): 251-257
        • Leysen M.
        • Nijs J.
        • Van Wilgen P.
        • Demoulin C.
        • Dankaerts W.
        • Danneels L.
        • Voogt L.
        • Köke A.
        • Pitance L.
        • Roussel N.
        Attitudes and beliefs on low back pain in physical therapy education: A cross-sectional study.
        Brazilian Journal of Physical Therapy. 2020; 25: 319-328
        • Lin Y.C.
        • Wan L.
        • Jamison R.N.
        Using integrative medicine in pain management: An evaluation of current evidence.
        Anesthesia and Analgesia. 2017; 125: 2081-2093
        • Majeed M.H.
        • Ali A.A.
        • Metzger S.
        • Sudak D.M.
        Pain management education and training during psychiatry residency: A report on national progress.
        Pain Medicine (Malden, Mass.). 2019; 20: 2346-2348
        • Moceri J.T.
        • Drevdahl D.J.
        Nurses' knowledge and attitudes toward pain in the emergency department.
        Journal of Emergency Nursing. 2014; 40: 6-12
        • Mossey J.M.
        Defining racial and ethnic disparities in pain management.
        Clinical Orthopaedics and Related Research. 2011; 469: 1859-1870
        • Neimeyer G.J.
        • Taylor J.M.
        • Zemansky M.
        • Rothke S.E.
        Do mandates matter? The impact of continuing education mandates on participation in continuing professional development activities.
        Professional Psychology: Research and Practice. 2013; 44: 105-111
        • O'Brien Pott M.
        • Blanshan A.S.
        • Huneke K.M.
        • Baasch Thomas B.L.
        • Cook D.A.
        What influences choice of continuing medical education modalities and providers? A national survey of U.S. physicians, nurse practitioners, and physician assistants.
        Academic Medicine. 2021; 96: 93-100
        • R Core Team
        The R project for statistical computing.
        R Foundation, 2021 (Retrieved Jan 12, 2021, from)
        • Rouleau G.
        • Gagnon M.P.
        • Côté J.
        • Payne-Gagnon J.
        • Hudson E.
        • Dubois C.A.
        • Bouix-Picasso J.
        Effects of e-learning in a continuing education context on nursing care: systematic review of systematic qualitative, quantitative, and mixed-studies reviews.
        Journal of Medical Internet Research. 2019; 21: e15118
        • Roy P.
        • Jackson A.H.
        • Baxter J.
        • Brett B.
        • Winter M.
        • Hardesty I.
        • Alford D.P.
        Utilizing a faculty development program to promote safer opioid prescribing for chronic pain in internal medicine resident practices.
        Pain Medicine (Malden, Mass.). 2019; 20: 707-716
        • Shahhosseini Z.
        • Hamzehgardeshi Z.
        The facilitators and barriers to nurses' participation in continuing education programs: A mixed method explanatory sequential study.
        Global Journal of Health Science. 2014; 7: 184-193
        • Shipton E.E.
        • Bate F.
        • Garrick R.
        • Steketee C.
        • Shipton E.A.
        • Visser E.J.
        Systematic review of pain medicine content, teaching, and assessment in medical school curricula internationally.
        Pain and Therapy. 2018; 7: 139-161
        • Simpson K.
        • Kautzman L.
        • Dodd S.
        The effects of a pain management education program on the knowledge level and attitudes of clinical staff.
        Pain Management Nursing. 2002; 3: 87-93
        • Strickler G.K.
        • Kreiner P.W.
        • Halpin J.F.
        • Doyle E.
        • Paulozzi L.J.
        Opioid Prescribing Behaviors - Prescription Behavior Surveillance System, 11 States, 2010-2016.
        Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002). 2020; 69: 1-14
        • Sun E.
        • Moshfegh J.
        • Rishel C.A.
        • Cook C.E.
        • Goode A.P.
        • George S.Z.
        Association of early physical therapy with long-term opioid use among opioid-naive patients with musculoskeletal pain.
        JAMA Network Open. 2018; 1e185909
      2. Defense & Veterans Center for Integrative Pain Management (DVCIPM). (2017). Joint Pain Education Program (JPEP). Retrieved Jan 11, 2022, from

      3. U.S. Food and Drug Administration (FDA). (2018). Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS). Retrieved April 23, 2022, from

      4. Centers for Disease Control and Prevention/Department of Health and Human Services (CDC/DHHS) (2022). Proposed 2022 CDC clinical practice guideline for prescribing opioids. Retrieved June 06, 2022, from

        • Webster F.
        • Bremner S.
        • Oosenbrug E.
        • Durant S.
        • McCartney C.J.
        • Katz J.
        From opiophobia to overprescribing: A critical scoping review of medical education training for chronic pain.
        Pain Medicine (Malden, Mass.). 2017; 18: 1467-1475
        • Yoo J.
        • De Gagne J.C.
        • Kim H.J.
        • Oh J.
        Development and evaluation of a web-based acute pain management education program for Korean registered nurses: A randomized controlled trial.
        Nurse Education in Practice. 2019; 38: 7-13
        • Yorkgitis B.K.
        • Paffett C.
        • Brat G.A.
        • Crandall M.
        Effect of surgery-specific opioid-prescribing education in a safety-net hospital.
        Journal of Surgical Research. 2019; 243: 71-74
        • Zhu W.
        • Chernew M.E.
        • Sherry T.B.
        • Maestas N.
        Initial Opioid Prescriptions among U.S. Commercially Insured Patients, 2012–2017.
        New England Journal of Medicine. 2019; 380: 1043-1052