The American Pain Society cites the failure of health care providers to routinely assess pain and pain relief as the most common reason for unrelieved pain in US hospitals Lack of knowledge on the part of nurses about pain and its treatment is one of the major barriers to achieving comfort for those in pain Thus, the purpose of this descriptive study was to determine the pain management knowledge of hospital-based nurses in a rural Appalachian area The nonpurposive sample consisted of 123 registered nurses The questionnaire consisted of three sections demographic items and two instruments designed to measure knowledge of opioid classification and pain management The overall pain management knowledge score was 67 4% The findings indicate a knowledge deficit specifically related to the behavioural indicators of pain, classification of opioid analgesics, properties of opioid analgesics and adjuvant medications, and incidence of addiction This sample of rural nurses demonstrates similar pain management knowledge compared to the reported scores of urban nurses These results may serve as the impetus to develop strategies to decrease the barriers to effective pain management Further education about pain management is warranted