Interventional Pain Management Examination Description

Updated May 2023

Physicians certifying in Interventional Pain Management must successfully complete a computer-based (written) examination. Physicians recertifying in Interventional Pain Management are required to successfully complete a computer-based (written) examination.

The Written Examination

The written certification examination consists of 200 multiple-choice items and is administered over a four-hour session. The written recertification examination consists of 100 multiple-choice items and is administered over a two-hour session. Each question has four potential responses, but only one correct answer. Each response to a question is scored as correct or not correct.

The outline below provides details of the subject areas (domains) covered on the examinations and the approximate percentage of items from each area. This domain listing is provided to help candidates prepare for the examination and is based on a comprehensive practice analysis of the key topics and knowledge in the specialty, as identified by practitioners, instructors, and other leaders in interventional pain management. Candidates should review this outline carefully and focus study on the areas listed. Each item on the examination is linked to a specific domain. The information in the outline is meant to serve as a study aid only and not as a guarantee of success in taking the examination.

Describe the concepts of pain (e.g., definition, types of pain, pain pathways, mechanisms).
Describe the epidemiology of pain, including how gender and genetics influence pain.
Describe the modalities of pain management (e.g., interventional, pharmacologic).

1. Demonstrate knowledge of basic anatomy and physiology.
  1. Neurophysiology of pain
  2. Central nervous system (e.g., brain, spinal cord)
  3. Peripheral nervous system (e.g., dermatomes, spinal roots, brachial and lumbar sacral plexus)
  4. Autonomic nervous system
  5. Head, neck, face, ear, nose, and throat
  6. Musculoskeletal (e.g., spine, joints, discs, facets, muscle, connective tissue)
  7. Urogenital and gastrointestinal systems
  8. Endocrine and metabolic systems
  9. Cardiovascular and respiratory systems
2. Identify and describe the clinical presentation of common and acute chronic pain syndromes or conditions.
  1. Headache and orofacial pain (e.g., trigeminal neuralgia, TMJ)
  2. Chronic pain (e.g., chest, abdominal, pelvic, visceral, urogenital)
  3. Acute pain (e.g., traumatic pain, post-operative, painful medical conditions)
  4. Complex regional pain syndromes and sympathetically mediated pain
  5. Spinal disorders and spinal cord injury
  6. Rheumatologic aspects of pain (e.g., incident pain, extremity, joint, myofascial)
  7. Central pain (e.g., CVA and MS, spasticity)
  8. Radiculopathy and peripheral neuropathy (e.g., post herpetic neuralgia, diabetic neuropathy, HIV/AIDS)
  9. Phantom limb syndrome
  10. Cancer treatment and associated pain, including palliative and hospice care
  11. Sickle cell
  12. Special populations (e.g., pediatric, geriatric)

Obtain a comprehensive pain history to identify and explore issues to be addressed including:
1. Onset, location, nature, duration, intensity, aggravating and relieving factors
2. Other relevant history (e.g., medication, family, social, medical and surgical)
Perform a physical examination that is appropriate for the diagnosis and treatment of pain.
Assess the physical, psychological, and social consequences of the patient’s pain (e.g., level of pain, disability, associated distress, suffering).
Assess patient pain using validated pain outcome questionnaires (e.g., Opiate Risk Tool, Patient Health Questionnaire-9, Oswestry Disability Index).
Review and interpret relevant patient medical records, imaging, and diagnostic studies.
Select and order appropriate studies for assessment of pain (e.g., radiological studies, electrodiagnostic studies, diagnostic nerve blocks, laboratory studies).

Identify appropriate pain management options for individual patients according to:
1. Medical condition
2. Current therapeutic multimodal medication regimens
3. Risk-benefit balance of treatment
4. Cost-effectiveness and alternative therapies
5. Evidence of efficacy
6. Patient culture
7. Cognitive awareness
8. Patient treatment expectations
Educate patient about the selected treatment plan and alternatives.
Prescribe appropriate medications to maximize patient outcomes (e.g., neuropathic, muscle relaxants, NSAIDs, opioids).
Identify when to seek advice from, or refer to, another specialist (e.g., surgeon, neurologist, rheumatologist, pulmonologist, physical therapist).
Counsel patient on appropriate after care and follow-up.
Ensure patient compliance with medication treatment plan (e.g., drug screen administration, PMP, pill count, medication security).

Evaluate and manage pain with focus on functional improvement utilizing:
1. Medication management
  1. Opioid management, including patient-controlled analgesia (PCA)
  2. Adjuvants (e.g., acetaminophen, NSAIDs, gabapentinoids, steroids, clonidine)
  3. Tricyclics
  4. SSRI, SNRI
  5. Stimulants
  6. Benzodiazepines
  7. Muscle relaxants
  8. Intravenous ketamine, lidocaine, dexmedetomidine
  9. Opioid antagonist medication
  10. Triptans
  11. Sleep aid
2. Interventional approaches
  1. Peripheral nerve block with and without catheters
  2. Neuraxial blocks with and without catheter
  3. Truncal blocks
  4. Sympathetic blocks and ablation
  5. Ganglion blocks and ablation
  6. Bursa and joint injections (e.g., steroid)
  7. Botox injections
  8. Neurolysis (e.g., RFA, chemical)
  9. Facet block
  10. Epidural injections (e.g., transforaminal, interlaminar)
  11. Cryoablation
  12. Neuromodulation
  13. Intrathecal pumps implantation and management
  14. Vertebroplasty /kyphoplasty
  15. Regenerative medicine
Describe the indications, benefits, and risks of the following treatment modalities:
1. Integrative medicine (e.g., nutrition, supplements, acupuncture, yoga)
2. Physical medicine and rehabilitation
  1. Temperature modalities (e.g., heat, cold, ultrasound)
  2. Manual medicine (e.g., Manipulation, mobilization, massage, traction)
  3. Exercise therapy
  4. Occupational therapy
  5. Physical therapy
  6. Functional restoration
3. Psychological interventions.
  1. Cognitive behavioral therapy
  2. Psychotherapy
  3. Relaxation training (e.g., mindful breathing, meditation)
  4. Self-management techniques
4. Hospice and palliative care

Describe the mechanism of action, pharmacology, adverse effects, drug interactions, indications, and contraindications for:
1. Local anesthetics
2. Nonsteroidal anti-inflammatory agents
3. Steroids
4. Opioid agonists and antagonists
5. Antipyretic analgesics (e.g., acetaminophen)
6. Antidepressants, anticonvulsants, and anxiolytics
7. Neuropathic pain medicines
8. Other relevant analgesic medicines (e.g., alpha agonist and antagonist, Beta blocker, NMDA antagonist, Ziconotide)
9. Muscle relaxants (e.g., Baclofen)
10. Alternative medications (e.g., supplements, minerals, vitamins, cannabinoids, THC)
11. Sedative hypnotics
Describe the different routes for analgesic drug delivery, factors governing choice of route, and side effects relevant to a particular route.
1. Oral
2. Sublingual and buccal
3. Intramuscular
4. Intranasal
5. Subcutaneous (including continuous infusion)
6. Intravenous (including continuous infusion)
7. PCA via different routes (i.e., intravenous, subcutaneous, and epidural)
8. Neuraxial (e.g., epidural, intrathecal)
9. Other routes (e.g., topical, transdermal, intraarticular, incisional, rectal)
Describe the physiologic outcomes of medication use.
1. Addiction and opioid use disorder
2. Tolerance and physical dependency
3. Detox and withdrawal symptoms
4. Hypogonadism
5. Placebo effect

Design and prepare the procedure suite with the appropriate medications, needles, instruments, and other needed equipment including emergency equipment.
Explain the importance of sterile technique for interventional procedures.
Explain the management of sedation (e.g., airway management, IV and PO sedation).
Demonstrate knowledge of needle manipulation for injections and procedures.
Describe appropriate positioning of patient for injections and procedures.
Demonstrate knowledge of radiation safety.
Demonstrate knowledge of ultrasound and fluoroscopy application for procedural and interventional techniques.
Demonstrate knowledge of the following blocks:
1. Occipital nerve block
2. Sphenopalatine ganglion block
3. Trigeminal nerve block
4. Stellate ganglion block
5. Brachial plexus blocks
6. Splanchnic plexus block
7. Celiac plexus block
8. Lumbosacral plexus blocks
9. Lumbar sympathetic block
10. Ganglion impar block
11. Medial branch blocks
12. Peripheral nerve blocks
Demonstrate knowledge of neurolysis (e.g., RFA, chemical)
Demonstrate knowledge and management of spinal cord and peripheral nerve stimulation systems.
Demonstrate knowledge and management of intrathecal delivery devices.
Demonstrate knowledge of the following procedures:
1. Epidural injection (e.g., interlaminar, transforaminal, selective nerve root blocks, caudal)
2. Peripheral joint injections
3. Facet joint injections
4. Sacroiliac joint injections and fusion
5. Myofascial injections
6. Discography and intradiscal injections
7. IDET/percutaneous disc decompression
8. MILD
9. Vertebral augmentation (e.g., vertebroplasty, kyphoplasty)

1. 1. Maintain clear, concise, accurate, and appropriate patient documentation (e.g., medical records, informed consent, disclosure of risk).
  2. Demonstrate knowledge of coding requirements, documentation, and reimbursement issues as it relates to Medicare/Medicaid guidelines.
  3. Describe the controlled substances act (e.g., CME and prescription management guidelines in accordance with federal and state legislation).
  4. Adhere to FSMB practice guidelines and ethical standards (e.g., living wills, advanced directives, DNR, durable power of attorney, right to receive or refuse treatment, discontinuation of patient-physician relationship).
  5. Identify legal and regulatory issues that affect or limit access to care for patients with pain and addiction.
  6. Collaborate and communicate with patients, caregivers, team members, and social services on the care plan while maintaining HIPPA compliance.
  7. Collaborate and communicate with other stakeholders (e.g., disability, lawyers, 3rd party payors).

References

A candidate should focus their examination preparation on the content provided in the examination blueprint. The reference list is not meant to be a list of comprehensive study materials but rather to aid candidates who may wish to prepare more in a specific area of the examination blueprint that they may not be as familiar with. You may wish to use the study materials to prepare for the written certification examination. All items appearing on examinations have been written based on the material presented in these study references.

Click here to Download Study References

Examination Administration

Click here for ABPS Examination Schedule Information

Examination Results

Candidates will receive score reports indicating their pass/fail status on the written examination. Candidates who fail are provided a breakdown of their performance by subject content domains. ABPS sends examination results to candidates within 60 days of the last day of the administration window. Each examination is scored against predetermined standards of acceptable performance, utilizing modified Angoff procedures for establishing the minimum acceptable scores. A candidate who is successful in passing the written examination is then approved to sit for the next administration of the oral certification examination. A candidate who is successful in passing the written recertification examination is then recertified and retains Diplomate status within ABPS and AAPS.

Retaking Examinations

A candidate may take the written examination as many as three times to attain a passing score. Candidates who are not successful in passing the examination within the number of allowable attempts may reapply for certification by completing a new application and meeting all the eligibility requirements in effect at the time the new application is submitted.