Pain and MSK Interventional Ultrasound Certificate
In recent years, one of the most important new developments in interventional pain management has been the introduction of ultrasound-guided pain procedures and musculoskeletal (MSK) injections. Real-time viewing of the target structures, the block needle trajectory, and injectate spread, as well as the critical structures to avoid, can ensure superior success and safety in pain management procedures. This is a quantum leap in technology for those interested in this pursuit, and ultrasound-guided pain intervention is drawing a large number of pain practitioners to adopt these new techniques. However, sonography images are subject to individual interpretation depending on one’s experiences and training.
No formal training on pain and MSK interventional ultrasound exists in most residency and fellowship programs. As such, physicians obtain training through attending hands-on workshops, as well as online educational activities. There is now an increasing trend for physicians to integrate interventional ultrasound in daily pain practice. Not surprisingly, payers, as well as hospital administrators, are expected to demand documented training, competency evaluation, and/or certifications.
The American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Pain and MSK Interventional Ultrasound Certificate Examination Board developed the eligibility requirements and examination materials for the Pain and MSK Interventional Ultrasound Certificate based on the best practices of Pain and MSK Interventional Ultrasound documented in medical literature. This certification recognizes currently accepted levels of knowledge and expertise in Pain and MSK Interventional Ultrasound to improve patient care.
The advancement of ultrasound technology and the range of possible clinical circumstances may give rise to other indications and approaches. Accordingly, the examination board will review the literature and the exam contents annually.
ASRA and the Pain and MSK Interventional Ultrasound Certificate Examination Board welcome feedback to improve the certification program, individual elements of eligibility requirements, or the written or practical exam.
Candidates who pass the exam will receive a certificate suitable for framing and may identify themselves as certified Pain and MSK Interventional Ultrasound physicians.
In order to attain the certificate, the candidate must first provide a completed application form with a $250 application fee and fulfill all of the following six requirements.
- Documentation of being a physician in good standing with: a. Valid, unrestricted license to practice medicine in the U.S. or your practicing country; b. Board certification in primary specialty (e.g., anesthesiology, physical medicine and rehabilitation, neurology...) or equivalent.
- Letters of recommendation from two colleagues who can testify to the applicant’s experience in Pain and MSK Interventional Ultrasound and his or her ethical and professional standards.
- One letter of recommendation from the chair of the applicant’s department or equivalent who can attest to the applicant’s good standing, experience in practice, and ethical and professional standards, as well as assess the quality of the individual’s independent practice in Pain and MSK Interventional Ultrasound.
- Documentation of participation in a minimum of 20 hours of AMA PRA Category 1 Credits™ or equivalent in CME program focused on ultrasound-guided pain and MSK intervention in the preceding two years. If the candidate attends a conference without such specification, only the workshop hours relevant to pain and MSK intervention will be included.
- Completed and signed procedure list (see application).
- Attestation of adherence to ethical and professional standards (see application).
If eligibility is met, the candidate will be asked to pay the $1,200 (member)/$1,475 (non-member) certification fee prior to being scheduled for the certification exam.
Please mail completed application form and all required materials to ASRA, Attn: Certificate Application, Three Penn Center West, Suite 224, Pittsburgh, PA 15276.
The ASRA Pain and MSK Ultrasound Cadaver Course is an example of a course that qualifies for the ultrasound training requirement. The ASRA Pain and MSK Ultrasound Cadaver Course currently offers 14.25 credits; therefore, additional CME program participation is needed to fulfill the entire 20-hour requirement.
Additional courses that have been approved for this requirement include:
- Ultrasound workshop(s) provided at the ASRA Annual Pain Medicine Meeting
- Ultrasound workshops provided by the American Society of Anesthesiologists (ASA)
- Ultrasound workshops provide by the European Society of Regional Anesthesia and Pain Therapy (ESRA)
- MSK workshops sponsored by the American Institute of Ultrasound Medicine (AIUM)
- Multidisciplinary Musculoskeletal Ultrasound Symposium on Pain Medicine (Hong Kong)
- Ultrasound Course for Interventional Pain, Musculoskeletal and Regenerative Medicine (NYSORA)
- World Academy of Pain Medicine Ultrasonography (WAPMU)
Additional courses will be evaluated for eligibility based on a strict set of requirements by an independent volunteer committee. NOTE: Approval of course(s) for this program does not indicate or imply ASRA involvement in the development of or endorsement of those course(s).
1. The application, supporting material, and $250 non-refundable application fee (credit card or check in USD funds) must be submitted together with the official application form. Forms submitted without all required materials will not be considered. If you have a preference for which date you wish to sit for the exam, please indicate it on your application form.
2. Only complete applications that are received by the deadline will be considered.
3. If the application is approved, the applicant will be notified that he or she has been approved as a Candidate for the Pain and MSK Interventional Ultrasound Certificate exam. Applicants not accepted as Candidates will not be refunded their application fee.
4. Approved Candidates must submit a $1,200 (member)/$1,475 (non-member) exam fee prior to being scheduled for the exam.
5. If a Candidate must reschedule a scheduled exam, a $200 rescheduling fee will be charged.
6. All correspondence will be sent to the address on the file.
7. The examination and all correspondence related to the examination will be in English.
8. Exam results are mailed to the Candidate at the address on file. Results will not be shared by phone or email.
9. Exam results will only be provided to the Candidate.
10. Both the written and practical exam components have minimum passing scores. Passing scores will not be shared.
11. Candidates must pass both the written and practical portions of the exam to earn the certificate.
12. Candidates who do not pass both the written and practical portions of the exam will be notified of their scores, the minimum passing score, and areas for improvement. These Candidates may reapply for the next testing period. See “Reapplying for the Examination.”
13. Candidates who fail the written exam and wish to challenge the results may request that the exam be rescored and verified. Candidates must appeal within 10 days of receiving exam results.
14. All examination answer sheets will be destroyed six months after administration.
Successful candidates for the Pain and MSK Interventional Ultrasound Certificate should have practiced a wide variety of the following procedures.
- Greater occipital nerve
- Stellate ganglion block
- Suprascapular nerve
- Intercostal nerves
- Iliohypogastric/ilioinguinal nerve/ TAP block
- Lateral femoral cutaneous nerve
- Celiac plexus block
- Inguinal canal/genital branch of genitofemoral nerve block
- Pudendal nerve
- UE/LE peripheral nerves
- Cervical selective nerve root
- Cervical facet periarticular
- Cervical medial branch
- Third occipital nerve
- Thoracic paravertebral block
- Lumbar medial branch
- Lumbar facet periarticular
- Sacroiliac joint
- Lumbar and thoracic interlaminar epidural
- Caudal and sacral foramina
- Upper extremity joints: Shoulder, elbow, wrist, hand
- Lower extremity joints: Hip, knee, ankle, foot
- Muscles (piriformis, etc.)
- Ligaments and peritendon space
- Nerves (e.g., Morton’s neuroma, Baxter nerve)
- Injection techniques (e.g., steroid, viscosupplement, platelet-rich plasma)
Narouze SN. Atlas of Ultrasound-Guided Procedures in Interventional Pain Management. 2nd ed. New York, NY: Springer-Verlag New York; 2018.
Peng P, Finlayson R, Lee SH, Bhatia A. Ultrasound for Pain Management. New York; NY: Springer International Publishing; 2020.
Candidates who fail one or both portions of the examination process are eligible to reapply for the next available test by completing and submitting all required forms by deadline and paying all fees again. No fees will be refunded from the failed attempt. Feedback will be provided from each examination taken to assist the candidate in preparing for subsequent attempts. There is no limit to the number of times a candidate may apply for the certificate.
Confidentiality of Testing Candidates
ASRA and its representatives will strive to maintain the confidentiality of applicants and candidates at all times and any information, including application status and test results, will only be released to the candidate at the address provided.
The Pain and MSK Interventional Ultrasound Certificate is valid for a period of ten (10) years. Candidate wishing to renew the certificate will be required to provide documentation of practice and CME and pay a renewal fee. The acronym for use if a candidate obtains the certification is ASRA-PMUC.
- Do you have to be a member of ASRA to earn the certificate?
No, you do not have to be a member of ASRA or a sister society (i.e., ESRA, AFSRA, AOSRA, or LASRA) to earn the certificate. The certificate process is open to anyone fulfilling the requirements.
- How much does the certificate cost?
The total cost is $1,450/$1,725: the application fee is $250, and candidates who are accepted for the certificate will then be required to pay a $1,200 (member)/$1,475 (non-member) certificate fee, which must be paid prior to being scheduled for the exam. Additional costs may be incurred to fulfill the CME requirement for eligibility. However, those costs are determined by the CME provider offering the respective course(s).
- Does the certificate expire?
The certificate is valid for 10 years, after which time the physician may renew the certificate.
- How long is the written exam?
The written exam consists of multiple-choice questions assessing the physician’s knowledge of pain and MSK interventional ultrasound techniques. Candidates will be given up to 90 minutes to complete the examination.
- How long is the practical exam?
The practical examination will be held in a one-on-one setting with an examiner and will consist of multiple stations assessing knowledge, judgment, and skill in pain and MSK intervention. Candidates will be given a clinical scenario and be asked to demonstrate critical thinking, medical knowledge, scanning and injection techniques, judgment, and communication. Candidates will be given up to two hours to complete this examination.
- On which procedures will I be tested during the practical exam?
You will be tested on the procedures that you use in practice, corresponding to the procedures you indicated on the “Procedure List” portion of the application.
- How do I know if a CME course qualifies for the ultrasound training portion of the requirements?
A list of acceptable courses will be provided on the ASRA website and updated periodically to reflect new offerings. All courses must fulfill specific requirements that are reviewed by a volunteer committee of experts on an ongoing basis. Additional courses will be evaluated for eligibility based on a strict set of requirements by an independent volunteer committee. To propose a course for evaluation, send an email to firstname.lastname@example.org. The ASRA administrative assistant will forward the suggestion to the committee for review and consideration.
- What's the acronym I can use if I've passed the exam?The acronym you can use is ASRA-PMUC.
- If I fail the written or practical exam, can I take it again?
If a physician fails one or both components of the exam, he or she must reapply at a future date. Application fees will not be reimbursed.
- Can I apply online?
The application form can be downloaded, completed electronically, and printed out to mail, along with the other required application materials, to the ASRA office at the following address:
Attn: Certificate Application
Three Penn Center West
Pittsburgh, PA 15276
Applications can also be emailed to email@example.com as a PDF file.
If you would like a copy of the Candidate's Guide mailed to you, complete the following.
Applications and all accompanying materials must be sent together as one package. If emailing your application, please combine your documents into a single PDF file. To download a PDF file of the guide, click here. This PDF document includes an application that can be completed electronically.
Mail materials to:
Attn: Certificate Application
Three Penn Center West
Pittsburgh, PA 15276
Please direct any questions to firstname.lastname@example.org.