I know several people that never did any actual interventional procedures before starting fellowship. I have seen a few that did a bunch, but clearly weren't trained that well as they were doing trying to do things that really made no sense. I think a lot of programs want to see that you can properly evaluate patients with the different pain syndromes and that you have a good handle on the anatomy. Some experience is a plus at some places, but most places I went didn't really care. Also if they wanted me to have a ton of experience before started I would also wonder how much they are really looking to teach during the fellowship vs just have me doing a bunch of procedures for them at distant supervision. I did a few procedures at a NASS course for residents, but none on actual patients. Between Accredited and non accredited places I had well over 10 interviews. Issue of my procedure volume only came up once, and it was a non-pain trained faculty member that was interviewing me that mentioned it, so I don't know if it really mattered there at all or not. When you apply you don't submit a procedure log, so most places will have no idea how many procedures you have done before deciding to interview you or not unless they are familiar with your program. Your competitiveness will largely be determined by what program you came from, your research, quality of letters, leadership and a few other things like SAE/USMLE, other experiences, etc that matter less than the first 3-4 things.
