Purpose
Chronic pain affects over 50 million adults annually in the United States and is a significant contributor to healthcare costs and lost productivity. Medical students' knowledge and attitudes toward pain management, particularly toward opioid use, shape their future clinical practice and quality of patient care. This study evaluates medical students' evolving knowledge, attitudes, and perceptions of chronic pain management across 4 years of medical training, providing insight into educational needs and curriculum development.

Methods
A survey was administered to medical students across four years of training (MD1-MD4) to assess knowledge of chronic pain management strategies (pharmacological and non-pharmacological) and attitudes toward opioid use. The survey included both quantitative and qualitative items covering treatment knowledge, attitudes toward opioid prescribing, and perceptions of stigma. Quantitative data were analyzed descriptively, and qualitative responses were reviewed for thematic insights. Preliminary analysis focused on MD1 responses (n=76).

Results
Knowledge levels varied significantly across topics, with mean scores ranging from 20.03 to 44.97 (scale 0-100). Students demonstrated cautious attitudes, with 51.4% agreeing that patients with chronic pain are more likely to become addicted than patients with acute pain. Confidence in managing chronic and acute pain was 22.04 and 30.66, respectively. Qualitative responses revealed themes of caution and concern around opioid use, with some students expressing stigma-related views towards patients with chronic pain. Many students also desired more structured education on multimodal pain management strategies. Results from upper-year students (MD2-MD4) will be available by the time of the conference.

Conclusions
Preliminary results suggest MD1 students have limited knowledge and confidence in opioid prescribing, most likely influenced by gaps in knowledge and potential stigma. These findings underscore the need for targeted early interventions to promote a balanced understanding of pain management. As longitudinal data from MD2-MD4 classes become available, comparisons across training levels will provide insights into medical students' evolving knowledge and attitudes.