The American Society of Pain and Neuroscience (ASPN) Guidelines for Advanced Practice Providers in Interventional Spine and Pain Management Practice

Casey Grillo,1 Alaa Abd-Elsayed,2 Tariq A Yousef,1 Brittney Misercola,3 Zohra Hussaini,4 Morteza Rabii,5 Ashley Comer,6 Kristen Durkin,7 Patrick McGinn,8 Timothy Deer6 1The Spine and Pain Institute of New York, New York, NY, USA; 2Anesthesiology Department, University of Wisconsin- Madison, Madison, WI, USA; 3Pain Specialists of America, Austin, TX, USA; 4Department of Anesthesiology, the University of Kansas Health System, Kansas City, KS, USA; 5Crimson Pain Management, Overland Park, KS, USA; 6The Spine and Nerve Center of the Virginias in Charleston, Charleston, WV, USA; 7NY Spine & Pain Specialists, Port Jefferson Station, NY, USA; 8National Spine and Pain Centers, Shrewsbury, NJ, USACorrespondence: Casey Grillo, The Spine and Pain Institute of New York, 860 Fifth Ave, Suite 1B, New York, NY, 10065, USA, Tel +1 212 724 7246, Fax +1 212 724 7256, Email [email protected]: Chronic pain management has advanced with minimally invasive interventions that reduce surgical trauma and recovery time. Specialized interventional spine clinics rely on multidisciplinary approaches to improve outcomes. Advanced Practice Providers (APPs), including nurse practitioners, physician assistants, and clinical nurse specialists, play increasingly important roles in these settings. However, standardized guidance on APP integration, training, and scope of practice remains limited. This guideline, developed by an expert panel, is the first to address APP roles in interventional pain management. It is intended for a broad audience including APPs, physicians, and healthcare administrators/policymakers who are involved in spine and pain management.Methods: In 2024, a multidisciplinary American Society of Pain and Neuroscience (ASPN) panel conducted a targeted literature review and iterative consensus process. Relevant studies, regulations, and guidelines up to 2025 were reviewed. No formal Delphi or grading system was used; recommendations were finalized by group agreement. Topics included APP training, regulatory frameworks, collaborative care models, procedural involvement, medication management, and future directions.Results: The panel identified nine domains central to APP practice. Recommendations emphasize structured specialty training with fellowship-style onboarding and ongoing competency maintenance; collaborative models in which APPs conduct evaluations, education, and peri-/post-procedural care, while physicians perform high-risk interventions; and strict adherence to state, payer, and institutional rules. ASPN does not endorse independent APP performance of advanced interventional procedures. APPs are key to patient safety through pre-procedure risk assessment, informed consent, and complication monitoring, and they play a central role in medication management, including reconciliation, non-opioid therapy, and opioid prescribing under collaborative frameworks with consistent risk-mitigation practices. Limitations include regulation variability, lack of standardized training pathways, and limited APP-specific outcome data.Conclusion: These consensus-based guidelines can expand access, improve safety, and enhance patient satisfaction. Standardizing APP roles and training will allow practices to meet rising demand while maintaining high-quality care. Continued evaluation of APP-driven outcomes and development of formal fellowships and certification pathways will be essential to refine these recommendations.Keywords: interventional pain, spine, advanced practice providers, nurse practitioner, physician assistant, clinical nurse specialist, guidelines