This study's objective was to determine the attitudes/beliefs and knowledge of West Virginia's family physicians regarding evaluation and treatment of patients with pain. A 20-item instrument (10 attitudinal/behavioral and 10 knowledge items) was mailed to 537 members of the West Virginia Chapter of the American Academy of Family Physicians in October 2002. Five percent of the surveys were mailed to out-of-state members. No follow-up questionnaire was mailed. A total of 186 surveys (186/537, 34.6%) were returned. The typical respondent was a male ages 30-54 graduating in 1983 or later and having 15.5 years of practice experience. The majority of respondents were in a solo or group practice. There were no differences in response rates according to age, gender, years in practice, and practice setting. Chronic nonmalignant pain and assessing pain in the elderly are problematic for many physician providers. Perceived regulatory scrutiny does impact physician prescribing of opioids for patients in pain. Knowledge gaps were uncovered in the areas of fentanyl administration, the use of propoxyphene in the elderly, the management of opioid-induced constipation, laxative prescription, and the use of oxygen to manage opioid-induced respiratory depression. The majority of respondents felt that their formal medical training did not prepare them to effectively manage pain. This survey provides valuable insight into the attitudes/behaviors and knowledge about pain and its management by West Virginia family physicians. A national sample, using a revised instrument, is needed to more fully characterize and validate the findings from this statewide survey.