Ultrasound (US) is a promising imaging technique in interventional pain management. It allows the identification of soft tissues, vessels, and nerves, without exposing patients and personnel to radiation. Imaging can be performed continuously and the fluid injected is visualized in a real-time fashion. Possible applications are nerve blocks of the cervical and lumbar zygapophysial joints, stellate ganglion block, intercostal nerve blocks, peripheral nerve blocks of the extremities, blocks of painful stump neuromas, caudal epidural injections, and injections of tender points. US can be used not only for local anesthetic blocks, but has a potential application for destructive procedures, such as cryoanalgesia, radiofrequency lesions, or chemical neurolysis. The very limited published data available and the clinical experience by the authors suggest that US has a potential usefulness in interventional pain management, but also has limitations. There is a need for clinical trials investigating efficacy and safety of US-guided pain procedures. Until these studies are made, US cannot replace fluoroscopy or computed tomography in routine clinical practice. Rather, only physicians who have been trained appropriately and practice under supervision of an experienced sonographer should use it, until familiarity with the method is gained.