100+ Free NSPM-C Practice Questions

Pass your NBCRNA Nonsurgical Pain Management Subspecialty Certification exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

Not publicly reported Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

According to NSPM certification standards, which type of educational requirement must be documented for NSPM credential eligibility (prior to the 2027 fellowship mandate)?

Completion of a 1-year ACGME-accredited pain fellowship

A minimum of 500 NSPM procedures documented in a log

Completion of education activities demonstrating acquired knowledge in anatomy/physiology of pain, assessment/diagnosis, pharmacology, interventional strategies, imaging safety, and professional aspects within 4 years

Completion of 100 CME hours in general anesthesia

to track

2026 Statistics

Key Facts: NSPM-C Exam

150

Scored Exam Questions

Plus 2–3 clinical scenarios

240 min

Exam Time Limit

NBCRNA NSPM program

24%

Assessment & Diagnosis

Largest content domain

Content Domains

NSPM Content Outline 2026

2 years

CRNA Experience Required

NBCRNA eligibility

2027

Fellowship Requirement

COA-accredited program required Jan 1, 2027

The NSPM-C examination contains 150 scored multiple-choice questions plus 2–3 clinical scenarios over 240 minutes. Content covers six domains with Assessment/Diagnosis/Plan of Care (24%) and Interventional Pain Strategies (20%) as the two largest. The exam is not computer-adaptive and is administered annually at computer-based testing centers. Eligibility requires current NBCRNA certification and 2 years of nurse anesthesia clinical practice. Beginning January 1, 2027, a COA-accredited post-master's pain fellowship is required for initial credentialing. Recertification transitions to a quarterly MAC Check longitudinal assessment format starting October 2026.

Sample NSPM-C Practice Questions

Try these sample questions to test your NSPM-C exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which neurotransmitter is primarily responsible for descending inhibitory pain modulation via the dorsolateral funiculus?

A.Substance P

B.Norepinephrine and serotonin

C.Glutamate

D.Calcitonin gene-related peptide (CGRP)

Explanation: Descending inhibitory pain pathways from the periaqueductal gray and rostral ventromedial medulla project through the dorsolateral funiculus and primarily release norepinephrine and serotonin in the dorsal horn, inhibiting pain transmission.

2A CRNA is performing an ultrasound-guided cervical medial branch block. Which landmark identifies the correct target for C4 medial branch?

A.The apex of the superior articular process at C4–C5

B.The waist of the articular pillar at the C4 level

C.The C4 transverse process posterior tubercle

D.The C4–C5 facet joint space

Explanation: The cervical medial branch nerves cross the waist (midpoint) of the articular pillar at each respective level. For the C4 medial branch, the target is the waist of the C4 articular pillar.

3When performing a lumbar epidural steroid injection using the interlaminar approach, which structure is identified by the loss-of-resistance technique?

A.Posterior longitudinal ligament

B.Ligamentum flavum

C.Interspinous ligament

D.Anterior epidural space

Explanation: The loss-of-resistance technique detects entry into the epidural space as the needle passes through the ligamentum flavum, which provides significant resistance. When resistance is lost, the needle tip is in the epidural space.

4Which opioid is considered most appropriate for patients with renal failure requiring around-the-clock opioid analgesia?

A.Morphine

B.Codeine

C.Methadone or fentanyl

D.Hydromorphone

Explanation: Methadone and fentanyl lack active renally-cleared metabolites and are preferred in renal failure. Morphine, codeine, and hydromorphone accumulate active metabolites (M6G, morphine-6-glucuronide; norcodeine; hydromorphone-3-glucuronide) that can cause CNS toxicity with renal impairment.

5A patient with chronic low back pain has a diagnosis of lumbar facet-mediated pain confirmed by two positive medial branch blocks. The next appropriate interventional step is:

A.Repeat epidural steroid injection

B.Radiofrequency ablation of the medial branch nerves

C.Spinal cord stimulator trial

D.Intradiscal electrothermal therapy (IDET)

Explanation: After two confirmatory medial branch blocks demonstrate ≥80% pain relief, radiofrequency ablation (RFA) of the corresponding medial branch nerves is the standard next step to provide longer-lasting relief of facet-mediated pain.

6Central sensitization is best characterized by which of the following mechanisms?

A.Decreased C-fiber firing threshold at peripheral nociceptors

B.Upregulation of NMDA receptor activity in dorsal horn neurons leading to increased excitability

C.Increased opioid receptor density in the periaqueductal gray

D.Downregulation of substance P release in the spinal cord

Explanation: Central sensitization involves wind-up and long-term potentiation in dorsal horn neurons, primarily driven by NMDA receptor activation. This leads to hyperalgesia, allodynia, and expansion of the receptive field.

7Which imaging modality is the gold standard for evaluating soft tissue structures such as intervertebral disc herniation and spinal cord pathology?

A.Plain radiograph (X-ray)

B.Computed tomography (CT)

C.Magnetic resonance imaging (MRI)

D.Bone scintigraphy (bone scan)

Explanation: MRI provides superior contrast resolution for soft tissue evaluation, making it the gold standard for assessing disc herniations, spinal cord compression, nerve root involvement, and other soft tissue pathology.

8A patient presents with burning, shooting pain in the lateral thigh without back pain. Which pain condition is most likely?

A.L3–L4 disc herniation with femoral nerve compression

B.Meralgia paresthetica (lateral femoral cutaneous nerve entrapment)

C.Greater trochanteric bursitis

D.Hip osteoarthritis

Explanation: Meralgia paresthetica is caused by compression of the lateral femoral cutaneous nerve (LFCN) at the inguinal ligament, producing burning, tingling, and numbness in the lateral thigh without motor deficit or back pain.

9Which validated tool is most appropriate for screening opioid misuse risk before initiating long-term opioid therapy?

A.Pain Catastrophizing Scale (PCS)

B.Opioid Risk Tool (ORT)

C.Brief Pain Inventory (BPI)

D.McGill Pain Questionnaire (MPQ)

Explanation: The Opioid Risk Tool (ORT) is a validated 5-item self-report questionnaire that stratifies patients into low, moderate, and high risk for opioid misuse or aberrant drug-related behaviors before initiating long-term opioid therapy.

10The gate control theory of pain proposes that pain perception is modulated at the spinal cord level primarily by activation of which fiber type?

A.C fibers (unmyelinated)

B.A-delta fibers (thinly myelinated)

C.A-beta fibers (large myelinated)

D.B fibers (preganglionic autonomic)

Explanation: The gate control theory (Melzack and Wall, 1965) proposes that activity in large-diameter A-beta fibers activates interneurons in the substantia gelatinosa that inhibit ('close the gate to') transmission of pain signals from small-diameter C and A-delta fibers.

About the NSPM-C Exam

The NSPM-C (Nonsurgical Pain Management Subspecialty Certification) is a voluntary credential issued by NBCRNA for CRNAs who practice in the subspecialty of nonsurgical pain management. Established in 2014 with first exams in 2015, it demonstrates advanced knowledge in six domains: Assessment/Diagnosis/Plan of Care (24%), Interventional Pain Strategies (20%), Pharmacology (19%), Anatomy/Physiology/Pathophysiology of Pain (19%), Safety and Equipment (11%), and Professional Aspects (7%). The exam consists of 150 scored multiple-choice items plus 2–3 clinical scenario items delivered over 240 minutes. It is not computer-adaptive. Eligibility requires current NBCRNA certification/CPC compliance, 2 years of nurse anesthesia clinical experience, and documented education in all six content areas within the prior 4 years (COA-accredited post-master's fellowship required from January 1, 2027). NBCRNA holds dual accreditation from NCCA and ABSNC for this credential.

Questions

150 scored questions

Time Limit

4 hours (240 minutes)

Passing Score

Criterion-referenced standard (specific score not published by NBCRNA)

Exam Fee

See current NBCRNA fee schedule (National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA))

NSPM-C Exam Content Outline

24%

Assessment, Diagnosis, and Plan of Care

Pain history and physical exam, validated assessment tools (NRS, BPI, ODI, ORT, DIRE), diagnostic imaging (MRI, CT, fluoroscopy, ultrasound), laboratory evaluation (ESR, CRP, UDS), differential diagnosis of common pain conditions, and individualized treatment planning

20%

Interventional Pain Strategies

Spinal procedures (interlaminar/transforaminal ESI, medial branch blocks at cervical/thoracic/lumbar/sacral levels, radiofrequency ablation, caudal epidural), sympathetic blocks (stellate ganglion, lumbar sympathetic, celiac plexus, superior hypogastric plexus, ganglion impar), peripheral nerve blocks, neuromodulation (SCS, DRG stimulation, intrathecal drug delivery), and complication management

19%

Pharmacology

Opioid pharmacology (mechanism of action, metabolism, rotation, equianalgesic dosing, OIH, OPIAD, PAMORA), non-opioid analgesics (NSAIDs, acetaminophen, topical agents), adjuvant analgesics (gabapentinoids, SNRIs, TCAs, ketamine, muscle relaxants, buprenorphine), corticosteroid selection for neuraxial use, and local anesthetic pharmacology

19%

Anatomy, Physiology, and Pathophysiology of Pain

Pain neuroscience (A-delta/C fiber types, dorsal horn processing, gate control theory, ascending pathways, descending modulation), spinal neuroanatomy (epidural space, sacral anatomy, DRG, sympathetic chain), peripheral sensitization and central sensitization mechanisms, pain classification (nociceptive, neuropathic, nociplastic), and pathophysiology of CRPS, fibromyalgia, and cancer pain

11%

Safety and Equipment

Fluoroscopy safety (ALARA, pulsed fluoroscopy, radiation minimization, DSA for vascular detection), ultrasound equipment selection (probe frequency, nerve identification), CT guidance for deep plexus blocks, ASRA anticoagulation guidelines for neuraxial/deep plexus procedures, LAST recognition and management (lipid emulsion), MRI safety and contraindications, and complication prevention/management

Professional Aspects

NSPM-C certification and recertification requirements, CRNA scope of practice in NSPM, opioid stewardship (CDC guidelines, PDMP monitoring, controlled substance agreements, urine drug screens), ethical principles (informed consent, patient autonomy), documentation standards, legal and regulatory responsibilities, and interdisciplinary coordination

How to Pass the NSPM-C Exam

What You Need to Know

Passing score: Criterion-referenced standard (specific score not published by NBCRNA)
Exam length: 150 questions
Time limit: 4 hours (240 minutes)
Exam fee: See current NBCRNA fee schedule

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

NSPM-C Study Tips from Top Performers

1Review the official NBCRNA NSPM Content Outline (effective March 2, 2026) and NSPM Bibliography as the primary study roadmap

2Master the anatomical landmarks for all four spinal regions (cervical, thoracic, lumbar, sacral) and three procedural approaches (midline, lateral, peripheral)

3Know ASRA anticoagulation guidelines for when to hold warfarin, novel anticoagulants, antiplatelets, and LMWH before neuraxial and deep plexus procedures

4Understand non-particulate vs. particulate corticosteroids and when dexamethasone must be used over triamcinolone or methylprednisolone

5Study opioid pharmacology in depth: rotation with incomplete cross-tolerance dose reduction, OIH mechanism, OPIAD, and PAMORA agents for OIC

6Learn diagnostic criteria distinguishing facet-mediated pain, discogenic pain, radiculopathy, and neuropathic pain syndromes for appropriate procedure selection

7Practice interpreting fluoroscopic landmarks for medial branch blocks, transforaminal ESI, and sympathetic chain blocks

8Understand SCS and DRG stimulation mechanisms, indications, and contraindications including cardiac pacemaker interactions

9Review CDC opioid prescribing guidelines, PDMP best practices, and controlled substance agreement requirements for professional aspects domain

10Study the NSPM-C exam structure: 150 questions + clinical scenarios, 240 minutes, non-adaptive — pace approximately 90 seconds per question

Frequently Asked Questions

What is the NSPM-C certification?

The NSPM-C (Nonsurgical Pain Management Subspecialty Certification) is a voluntary specialty credential issued by NBCRNA for certified registered nurse anesthetists (CRNAs) who practice in nonsurgical pain management. Established in 2014, it validates advanced knowledge across six domains including interventional procedures, pharmacology, pain neuroscience, assessment, safety, and professional practice. NBCRNA holds dual accreditation from NCCA and ABSNC for this credential.

How many questions are on the NSPM-C exam and how long is it?

The NSPM-C examination consists of 150 scored multiple-choice questions plus 2–3 clinical scenario items. The total time allowed is 240 minutes (4 hours). The exam is not computer-adaptive — all candidates receive the same question format.

What are the eligibility requirements for the NSPM-C?

To be eligible for the NSPM-C, you must have: (1) Current NBCRNA Full Recertification or CPC compliance, (2) Current nurse anesthesia clinical practice, (3) Current RN and (if applicable) APRN licensure, (4) At least 2 years of nurse anesthesia clinical experience, and (5) Documented completion of education activities covering all six NSPM content domains within the prior 4 years. Beginning January 1, 2027, a COA-accredited post-master's Pain Management Fellowship is required.

What content areas are covered on the NSPM-C exam?

The NSPM-C content outline (effective March 2026) covers six domains: Assessment, Diagnosis, and Plan of Care (24%); Interventional Pain Strategies (20%); Pharmacology (19%); Anatomy, Physiology, and Pathophysiology of Pain (19%); Safety and Equipment (11%); and Professional Aspects (7%). The exam assesses needle placement in three anatomical approaches (midline, lateral, peripheral) and four anatomical regions (cervical, thoracic, lumbar, sacral).

How do I maintain the NSPM-C credential?

Beginning October 2026, NBCRNA transitions NSPM-C maintenance to a longitudinal assessment model. Credential holders will answer 10 quarterly NSPM-related knowledge check questions within their MAC Check dashboard, replacing the prior point-in-time recertification examination. This aligns NSPM-C maintenance with the broader MAC program framework.

What is changing about NSPM-C eligibility in 2027?

Starting January 1, 2027, CRNAs seeking initial NSPM-C certification must complete a COA-accredited post-master's Pain Management Fellowship as part of the education requirements. Currently accredited fellowship programs include Texas Christian University (TCU) and the University of South Florida (USF). The fellowship requirement replaces the prior pathway of documenting individual education activities across the six content domains.

How should I prepare for the NSPM-C exam?

Preparation should cover all six content domains with emphasis on the higher-weight areas: Assessment/Diagnosis (24%), Interventional Strategies (20%), Pharmacology (19%), and Pain Anatomy/Physiology (19%). Review the official NSPM Content Outline and Bibliography from NBCRNA, study interventional technique landmarks and complications, master opioid pharmacology and stewardship principles, and review ASRA anticoagulation and safety guidelines. Practice with exam-style questions across all domains.

Where is the NSPM-C exam offered?

The NSPM-C examination is offered annually at computer-based testing centers throughout the United States. It is not available via remote proctoring. The exam is computer-delivered but not computer-adaptive. Contact NBCRNA at nbcrna.com or support@nbcrna.com for current testing windows and registration information.