1. Minimum 5 years in full time practice (or equivalent) prior to sitting the certification examination.
2. Minimum 1 year as IVAPM member prior to sitting the certification examination
3. CV/Biography with picture of applicant
4. Three letters of recommendation

   Letters preferably written by a Diplomate (AVMA, AVA, ECV, or regional equivalent), CVA, CCRP, CCRT, CCRA, VTS, or DAAPM 1

   Alternative option:

   For those members that lack access to any of the above veterinary pain related certified professionals, consider any licensed veterinary health professional or licensed human health professional 2

   Member should include a letter clarifying their need for this alternative option

   A standardized form will be provided by the IVAPM to facilitate the reference process

5. CME requirements

   A licensed veterinary health professional or licensed human health professional and two years of clinical experience working with animals in pain.

   90 hours pain management related CME during past 8 years

   1. Acceptable CME 3
      1. Major veterinary and human meeting pain related CME
      2. Judgments will have to be made, as inclusively as is reasonable, by the Applications Committee
   2. Rehab and acupuncture training programs
      1. Canine Rehabilitation Institute, University of Tennessee Rehab
      2. Chi Institute, MAS/Colorado, IVAS
   3. Internship/observation time spent at anesthesia/pain management services, up to a limit of 45 total CME equivalent hours. The candidate will need to include a letter describing the characteristics and capabilities of pain management related services at which they are observing patient care. The observational mentor will need to sign a log listing the days and hours the applicant spent on their service.
      1. Veterinary Teaching Hospital with Diplomate (ACVA, ACVECC, AVA, ECVAA, AAPM or regional equivalent), VTS (ECC, Anesthesia) conducting advanced pain management services.
      2. Private veterinary pain management practice with Diplomate (ACVA, ACVECC, AVA, ECVAA, AAPM or regional equivalent), VTS (ECC, Anesthesia) conducting advanced pain management services.
      3. Human pain management practice (with pain management physician). Approval will be on a case by case basis by the Applications Committee.
      4. Diplomates not listed above will be considered as suitable observational mentors assuming they are conducting advanced pain management services. Approval will be on a case by case basis by the Applications Committee.
   4. Internship/observation time spent observing pain oriented patient management with a certified veterinary or licensed human rehabilitation professional OR internship/observation time spent with a certified veterinary or human acupuncturist up to a limit of 20 total CME equivalent hours. The candidate will need to include a letter describing the characteristics and capabilities of pain management related services at which they are observing patient care. The observational mentor will need to sign a log listing the days and hours the applicant spent on their service.
   5. RACE approved onsite or online pain management CME hours
   6. Online pain related CME from all major veterinary and human pain related organizations (APS, IASP, WIP, ASRA, AAPM, IVIS, and VIN)
   7. Non-RACE approved online Industry based CME will be considered on a case by case basis by the Applications Committee
6. Test 4

   100 multiple choice, time limited (3 hour), closed book examination

   1. The test will be the same for all qualified applicants
   2. This test would emphasize foundational pain related principles while including elements specific to physical rehabilitation therapy and acupuncture as they relate to pain management
   3. Develop second year test while aiming toward larger test pool
   4. Develop an example test at some point in the future
7. The applicant must be able to demonstrate competency in any 10 of the following pain management related skills subcategories 5

   Skills subcategories

   1. Allopathic oriented skills (9 options)
      1. Epidural drug selection
      2. Epidural needle placement
      3. Epidural catheter placement
      4. Local/regional anesthesia/analgesia drug selection (injectable, transdermal) and placement for blocks in at least three of the following subcategories
         1. Declaw ring block
         2. Dental blocks (3 minimum)
         3. Intra-testicular
         4. Intra-articular
         5. Intercostal
         6. Transdermal applications
      5. Advanced local/regional anesthesia/analgesia drug selection and drug placement in at least two of the following subcategories
         1. Axillary, sciatic, or femoral nerve
         2. Intrapleural or intraperitoneal
         3. Bier Block
         4. Continuous local anesthetic administration (Intrapleural, Soaker catheter)
      6. Use of nerve locator for regional anesthesia/analgesia application purposes
      7. Constant rate infusion analgesic drug selection
      8. Constant rate infusion analgesic drug dose/volume calculations and administration using a volume base syringe pump
      9. Constant rate infusion analgesic drug dose/volume calculations and administration using IV fluids
   2. Physical rehabilitation skills (11 options) 6
      1. Goniometry
      2. Muscle mass measurement
      3. Neurologic examination/assessment
      4. Low level laser utilization (LLLT)
      5. NMES
      6. TENS
      7. Therapeutic U/S
      8. Joint compressions
      9. Joint mobilizations
      10. Joint traction
      11. Therapeutic massage
   3. Acupuncture skills (4 options) 7
      1. Needle placement techniques
      2. Needle removal techniques
      3. Pain related acupuncture point selection
      4. Electro-stimulation unit utilization
8. Verification of skills competency

   Signed off by Diplomate (AVMA, AVA, ECV, AAPM or regional equivalent), CVA, CCRP, CCRT, CCRA, VTS, DAAPM 8

   Alternative option:
   For those members that lack access to any of the above pain related certified professionals, consider any licensed veterinary health professional or licensed human health professional 9

   Member should include a letter clarifying their need for this alternative option

   Video documentation may be considered as an option for applicant when an AVMA Diplomate, AVA/ECV Diplomate, CVA, CCRP, CCRT, CCRA, VTS, DAAPM, or other licensed veterinary or human health professional are not available

   The applicant must list and include digital images of the following pain management related elements based upon the particular pain related services provided by the applicant

9. Available pain management drugs for those providing allopathic based therapy
   1. List should reflect drugs from the major analgesic categories listed below
      1. Opioids
      2. NMDA antagonists
      3. Na channel blockers
      4. Ca channel blockers
      5. NSAIDs
   2. Pictures should include the controlled drug storage and record keeping as required by regional laws and regulations
   3. For drugs that are not available onsite, member must describe their access to these medications
10. Equipment based on the pain management related services provided by the applicant
    1. Allopathic oriented examples (3 required)
       1. IV fluid pump or IV syringe pump
       2. Epidural supplies
       3. CRI calculators/recipe resources
       4. Nerve locator
    2. Rehabilitation; Rehab equipment (7 required)
       1. Goniometer
       2. Gulick tape measure
       3. TENS
       4. NMES
       5. Therapeutic U/S
       6. Low level laser
       7. Cavaletti rails
       8. Therapy balls, therapy bands
       9. Balance boards
    3. Acupuncture/TCVM (2 required)
       1. Needles
       2. Herbals
       3. Electro-stimulation unit

    Alternative pathway option
    The IVAPM acknowledges that some members are not currently in a setting that allows access to any of the above drugs and equipment. An example would be those in a purely teaching oriented position. A waiver will be considered for those in similarly limited settings with such waivers being extended by the Applications Committee on a case by case basis.

    Member should include a letter clarifying their need for this alternative option

11. Case reports
    1. Two total case reports will be required
       1. Case reports may pertain to perioperative, major acute medical or traumatic, or chronic pain management.
       2. Case reports must present different pain related scenarios.
       3. Case reports should employ a well-structured, balanced analgesic strategy.
    2. Review criteria will be the same for all applicants.
    3. Should involve patient care delivered during the 5-year period preceding the applicant’s examination date.
    4. Must be submitted within 6 months of the successful completion of the examination.
    5. Each case report should reflect a coherent, cogent thought process regarding patient assessment and management, above and beyond what might be considered for publication in JAVMA or other peer reviewed journals indexed in Pubmed.
    6. Must be in English, typed in 12-font Times New Roman, double-spaced, and limited to 2000 words.
    7. Format (in order):
       1. Cover page to include Title and Applicant Registration Number. Do not write your name anywhere on the report.
       2. Applicant Registration Number: Please include in the upper right hand corner of each page.
       3. Introduction: Include on a separate page. Introduction should state the type of pain management case featured in the report, a brief listing of therapeutic modalities and/or pharmaceuticals used and outcome. The IVAPM looks favorably upon an integrated, multidisciplinary and/or multimodal approach to the management of pain with the use of physical modalities (including but not limited to: physical rehabilitation, physiotherapy, acupuncture, etc.) as well as pharmacologic interventions whenever possible.
       4. Clinical Report: Should consist of clinical history, findings, subjective assessments, objective assessments (including measurements, diagnostic findings, etc.). A detailed description of the pain management protocol employed including all therapeutic modalities and/or pharmaceuticals, and responses to therapy. All laboratory data should be formatted in a table.
       5. Clinical Outcome: A subjective and objective response to therapy (use of a pain- or disability-scoring system required). In chronic pain patients include recommended long-term pain management.
       6. Discussion: Author’s subjective critique. Can include rationale for use of analgesics and physical modalities, critical evaluation of patient care, deficiencies, and areas of possible case management improvement
       7. Summary: Provides an interpretive summary of the case report.
       8. References: Placed as Endnotes to document. References may include standard reference texts, online reference material (e.g. www.ivis.org, www.vin.com), conference proceedings, and peer-review literature as indexed in PubMed (www.pubmed.org).
    8. Case Report will be graded by the following scores:
       1. Pass
       2. Fail
       3. Resubmit with corrections
12. Future planning and adaptations

    A lab animal/exotics subcommittee will be convened to adapt this program, if needed, to this area of veterinary practice

    A large animal/food animal subcommittee will be convened to adapt this program to this area of veterinary practice

    An international subcommittee will be convened to adapt all aspects of this program to other regions around the world

    This subcommittee will need to work with the Examination Committee to structure the most appropriate deployment of our examination to other regions of the world.

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Footnotes

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1. This encourages networking with colleagues who are often well positioned to be supportive of pain related case management

2. This option removes any restriction associated with professionals in more remote settings while helping the applicant network with their colleagues on the subject of pain management

3. The intent here is to parallel the established North American certification programs to establish legitimacy within our current core membership with adjustments considered as needed by the International subcommittee as this program is deployed around the world. In addition, we need to be VERY broad based in our early acceptance of CME equivalence as an acknowledgement that this discipline is in its infancy and that it is currently very difficult to gain 90 CME hours in a lecture setting, especially for technicians.

4. An Examination Committee will be formed to develop this specific component

5. One hoped for aspect of the skills list is to encourage networking with allied pain related professionals. An allopathic only practitioner will be encouraged to gain a few physical rehab skills or learn more about acupuncture’s ability to enhance pain management.

6. PTs and PTAs will need to accomplish all of their skills within the physical rehabilitation therapy category. I do not think that they will be able to legally perform the allopathic related techniques or acupuncture on animals.

7. In general, the acupuncturists should also be DVMs making them eligible to perform all of the allopathic techniques listed.

8. This encourages networking with colleagues who are often well positioned to be supportive of pain related case management

9. This option removes any restriction associated with professionals in more remote settings while helping the applicant network with their colleagues on the subject of pain management