Background <p>Effective pain management is central to surgical nursing, yet nurses often face challenges in practice. Self-efficacy influences nurses’ ability to manage pain, whereas attitudes toward complementary and alternative medicine (CAM) may also shape clinical decision-making. However, little is known about how CAM attitudes are related to surgical nurses’ pain management self-efficacy. This study aimed to investigate the relationships between complementary and alternative therapy attitudes and pain management self-efficacy among surgical nurses.</p> Methods <p>A cross-sectional analytical study was conducted with 153 surgical nurses working at a foundation university hospital in a metropolitan city in Turkey. Data were collected using a descriptive questionnaire, the Pain Management Self-Efficacy Questionnaire, and the Holistic Complementary and Alternative Medicine Questionnaire. Associations were analyzed with multiple linear regression.</p> Results <p>Higher holistic health attitudes significantly and negatively predicted comprehensive (B = − 0.497, <i>p</i> = 0.001), evaluative (B = − 0.104, <i>p</i> = 0.009), supplemental (B = − 0.072, <i>p</i> = 0.035), and total self-efficacy scores (B = − 0.674, <i>p</i> = 0.001).</p> Conclusion <p>This study revealed that surgical nurses’ favorable holistic health attitudes were associated with lower pain management self-efficacy. Recognizing this gap highlights the need to integrate evidence-based CAM content into undergraduate and continuing education and to develop institutional protocols that support holistic approaches. Such strategies may enhance nurses’ competence and confidence, ultimately improving patient-centered pain care. Future longitudinal and interventional studies are needed to confirm whether embedding CAM education strengthens self-efficacy in clinical practice.</p> Clinical trial number <p>Not applicable.</p>