CRNAs can practice in all 50 states independent of anesthesiologists. They must practice with a physician, however, but due to the nature of the work, this is seldomly a problem. The so called opt-out status on the state level has absolutely nothing to do with supervision and practice rights, but instead Medicare reimbursement. And yes, some CRNAs, albeit few, practice pain management outside of the peri-operative period.