69–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 110–871 

NATIONAL PAIN CARE POLICY ACT OF 2008 

SEPTEMBER 23, 2008.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. DINGELL, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 2994] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 2994) to amend the Public Health Service Act with 

respect to pain care, having considered the same, reports favorably 

thereon with an amendment and recommends that the bill as 

amended do pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 1 

Purpose and Summary ............................................................................................ 5 

Background and Need for Legislation .................................................................... 5 

Hearings ................................................................................................................... 6 

Committee Consideration ........................................................................................ 6 

Committee Votes ...................................................................................................... 6 

Committee Oversight Findings ............................................................................... 6 

Statement of General Performance Goals and Objectives .................................... 6 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 6 

Earmarks and Tax and Tariff Benefits .................................................................. 7 

Committee Cost Estimate ....................................................................................... 7 

Congressional Budget Office Estimate ................................................................... 7 

Federal Mandates Statement ................................................................................. 9 

Advisory Committee Statement .............................................................................. 9 

Constitutional Authority Statement ...................................................................... 9 

Applicability to Legislative Branch ........................................................................ 9 

Section-by-Section Analysis of the Legislation ...................................................... 9 

Changes in Existing Law Made by the Bill, as Reported ..................................... 11 

AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘National Pain Care Policy Act 

of 2008’’. 

(b) TABLE OF CONTENTS.—The table of contents of this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Institute of Medicine Conference on Pain. 

Sec. 3. Pain research at National Institutes of Health. 

Sec. 4. Pain care education and training. 

Sec. 5. Public awareness campaign on pain management. 

SEC. 2. INSTITUTE OF MEDICINE CONFERENCE ON PAIN. 

(a) CONVENING.—Not later than June 30, 2009, the Secretary of Health and 

Human Services shall seek to enter into an agreement with the Institute of Medicine of the National Academies to convene a Conference on Pain (in this section referred to as ‘‘the Conference’’). 

(b) PURPOSES.—The purposes of the Conference shall be to— 

(1) increase the recognition of pain as a significant public health problem in 

the United States; 

(2) evaluate the adequacy of assessment, diagnosis, treatment, and management of acute and chronic pain in the general population, and in identified racial, ethnic, gender, age, and other demographic groups that may be disproportionately affected by inadequacies in the assessment, diagnosis, treatment, and 

management of pain; 

(3) identify barriers to appropriate pain care, including— 

(A) lack of understanding and education among employers, patients, 

health care providers, regulators, and third-party payors; 

(B) barriers to access to care at the primary, specialty, and tertiary care 

levels, including barriers— 

(i) specific to those populations that are disproportionately undertreated for pain; 

(ii) related to physician concerns over regulatory and law enforcement policies applicable to some pain therapies; and 

(iii) attributable to benefit, coverage, and payment policies in both 

the public and private sectors; and 

(C) gaps in basic and clinical research on the symptoms and causes of 

pain, and potential assessment methods and new treatments to improve 

pain care; and 

(4) establish an agenda for action in both the public and private sectors that 

will reduce such barriers and significantly improve the state of pain care research, education, and clinical care in the United States. 

(c) OTHER APPROPRIATE ENTITY.—If the Institute of Medicine declines to enter 

into an agreement under subsection (a), the Secretary of Health and Human Services may enter into such agreement with another appropriate entity. 

(d) REPORT.—A report summarizing the Conference’s findings and recommendations shall be submitted to the Congress not later than June 30, 2010. 

(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this section, there is authorized to be appropriated $500,000 for each of fiscal years 2009 

and 2010. 

SEC. 3. PAIN RESEARCH AT NATIONAL INSTITUTES OF HEALTH. 

Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et seq.) is 

amended by adding at the end the following: 

‘‘SEC. 409J. PAIN RESEARCH. 

‘‘(a) RESEARCH INITIATIVES.— 

‘‘(1) IN GENERAL.—The Director of NIH is encouraged to continue and expand, 

through the Pain Consortium, an aggressive program of basic and clinical research on the causes of and potential treatments for pain. 

‘‘(2) ANNUAL RECOMMENDATIONS.—Not less than annually, the Pain Consortium, in consultation with the Division of Program Coordination, Planning, and 

Strategic Initiatives, shall develop and submit to the Director of NIH recommendations on appropriate pain research initiatives that could be undertaken with funds reserved under section 402A(c)(1) for the Common Fund or 

otherwise available for such initiatives. 

‘‘(3) DEFINITION.—In this subsection, the term ‘Pain Consortium’ means the 

Pain Consortium of the National Institutes of Health or a similar trans-National Institutes of Health coordinating entity designated by the Secretary for 

purposes of this subsection. 

‘‘(b) INTERAGENCY PAIN RESEARCH COORDINATING COMMITTEE.— 

‘‘(1) ESTABLISHMENT.—The Secretary shall establish not later than 1 year 

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mittee, to be known as the Interagency Pain Research Coordinating Committee 

(in this section referred to as the ‘Committee’), to coordinate all efforts within 

the Department of Health and Human Services and other Federal agencies that 

relate to pain research. 

‘‘(2) MEMBERSHIP.— 

‘‘(A) IN GENERAL.—The Committee shall be composed of the following voting members: 

‘‘(i) Not more than 7 voting Federal representatives as follows: 

‘‘(I) The Director of the Centers for Disease Control and Prevention. 

‘‘(II) The Director of the National Institutes of Health and the directors of such national research institutes and national centers as 

the Secretary determines appropriate. 

‘‘(III) The heads of such other agencies of the Department of 

Health and Human Services as the Secretary determines appropriate. 

‘‘(IV) Representatives of other Federal agencies that conduct or 

support pain care research and treatment, including the Department of Defense and the Department of Veterans Affairs. 

‘‘(ii) 12 additional voting members appointed under subparagraph 

(B). 

‘‘(B) ADDITIONAL MEMBERS.—The Committee shall include additional voting members appointed by the Secretary as follows: 

‘‘(i) 6 members shall be appointed from among scientists, physicians, 

and other health professionals, who— 

‘‘(I) are not officers or employees of the United States; 

‘‘(II) represent multiple disciplines, including clinical, basic, and 

public health sciences; 

‘‘(III) represent different geographical regions of the United 

States; and 

‘‘(IV) are from practice settings, academia, manufacturers or 

other research settings; and 

‘‘(ii) 6 members shall be appointed from members of the general public, who are representatives of leading research, advocacy, and service 

organizations for individuals with pain-related conditions. 

‘‘(C) NONVOTING MEMBERS.—The Committee shall include such nonvoting 

members as the Secretary determines to be appropriate. 

‘‘(3) CHAIRPERSON.—The voting members of the Committee shall select a 

chairperson from among such members. The selection of a chairperson shall be 

subject to the approval of the Director of NIH. 

‘‘(4) MEETINGS.—The Committee shall meet at the call of the chairperson of 

the Committee or upon the request of the Director of NIH, but in no case less 

often than once each year. 

‘‘(5) DUTIES.—The Committee shall— 

‘‘(A) develop a summary of advances in pain care research supported or 

conducted by the Federal agencies relevant to the diagnosis, prevention, 

and treatment of pain and diseases and disorders associated with pain; 

‘‘(B) identify critical gaps in basic and clinical research on the symptoms 

and causes of pain; 

‘‘(C) make recommendations to ensure that the activities of the National 

Institutes of Health and other Federal agencies, including the Department 

of Defense and the Department of Veteran Affairs, are free of unnecessary 

duplication of effort; 

‘‘(D) make recommendations on how best to disseminate information on 

pain care; and 

‘‘(E) make recommendations on how to expand partnerships between public entities, including Federal agencies, and private entities to expand collaborative, cross-cutting research. 

‘‘(6) REVIEW.—The Secretary shall review the necessity of the Committee at 

least once every 2 years.’’. 

SEC. 4. PAIN CARE EDUCATION AND TRAINING. 

(a) PAIN CARE EDUCATION AND TRAINING.—Part D of title VII of the Public Health 

Service Act (42 U.S.C. 294 et seq.) is amended— 

(1) by redesignating sections 754 through 758 as sections 755 through 759, 

respectively; and 

(2) by inserting after section 753 the following: 


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‘‘SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE. 

‘‘(a) IN GENERAL.—The Secretary may make awards of grants, cooperative agreements, and contracts to health professions schools, hospices, and other public and 

private entities for the development and implementation of programs to provide 

education and training to health care professionals in pain care. 

‘‘(b) PRIORITIES.—In making awards under subsection (a), the Secretary shall give 

priority to awards for the implementation of programs under such subsection. 

‘‘(c) CERTAIN TOPICS.—An award may be made under subsection (a) only if the applicant for the award agrees that the program carried out with the award will include information and education on— 

‘‘(1) recognized means for assessing, diagnosing, treating, and managing pain 

and related signs and symptoms, including the medically appropriate use of controlled substances; 

‘‘(2) applicable laws, regulations, rules, and policies on controlled substances, 

including the degree to which misconceptions and concerns regarding such laws, 

regulations, rules, and policies, or the enforcement thereof, may create barriers 

to patient access to appropriate and effective pain care; 

‘‘(3) interdisciplinary approaches to the delivery of pain care, including delivery through specialized centers providing comprehensive pain care treatment 

expertise; 

‘‘(4) cultural, linguistic, literacy, geographic, and other barriers to care in underserved populations; and 

‘‘(5) recent findings, developments, and improvements in the provision of pain 

care. 

‘‘(d) PROGRAM SITES.—Education and training under subsection (a) may be provided at or through health professions schools, residency training programs, and 

other graduate programs in the health professions; entities that provide continuing 

education in medicine, pain management, dentistry, psychology, social work, nursing, and pharmacy; hospices; and such other programs or sites as the Secretary determines to be appropriate. 

‘‘(e) EVALUATION OF PROGRAMS.—The Secretary shall (directly or through grants 

or contracts) provide for the evaluation of programs implemented under subsection 

(a) in order to determine the effect of such programs on knowledge and practice of 

pain care. 

‘‘(f) PEER REVIEW GROUPS.—In carrying out section 799(f) with respect to this section, the Secretary shall ensure that the membership of each peer review group involved includes individuals with expertise and experience in pain care. 

‘‘(g) DEFINITIONS.—For purposes of this section the term ‘pain care’ means the assessment, diagnosis, treatment, or management of acute or chronic pain regardless 

of causation or body location.’’. 

(b) AUTHORIZATION OF APPROPRIATIONS.—Section 758(b)(1) of the Public Health 

Service Act (as redesignated by subsection (a)(1) of this section) is amended— 

(1) by striking ‘‘and’’ at the end of subparagraph (B); 

(2) by striking the period at the end of subparagraph (C) and inserting ‘‘; 

and’’; and 

(3) by inserting after subparagraph (C) the following: 

‘‘(D) not less than $5,000,000 for awards of grants, cooperative agreements, and contracts under sections 754.’’. 

(c) TECHNICAL AMENDMENTS.—Title VII of the Public Health Service Act (42 

U.S.C. 292 et seq.) is amended— 

(1) in paragraph (2) of section 757(b) (as redesignated by subsection (a)(1)), 

by striking ‘‘754(3)(A), and 755(b)’’ and inserting ‘‘755(3)(A), and 756(b)’’; and 

(2) in subparagraph (C) of section 758(b)(1) (as redesignated by subsection 

(a)(1)), by striking ‘‘754, and 755’’ and inserting ‘‘755, and 756’’. 

SEC. 5. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGEMENT. 

Part B of title II of the Public Health Service Act (42 U.S.C. 238 et seq.) is amended by adding at the end the following: 

‘‘SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN MANAGEMENT. 

‘‘(a) ESTABLISHMENT.—Not later than June 30, 2009, the Secretary shall establish 

and implement a national pain care education outreach and awareness campaign 

described in subsection (b). 

‘‘(b) REQUIREMENTS.—The Secretary shall design the public awareness campaign 

under this section to educate consumers, patients, their families, and other caregivers with respect to— 

‘‘(1) the incidence and importance of pain as a national public health problem; 


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‘‘(2) the adverse physical, psychological, emotional, societal, and financial consequences that can result if pain is not appropriately assessed, diagnosed, treated, or managed; 

‘‘(3) the availability, benefits, and risks of all pain treatment and management options; 

‘‘(4) having pain promptly assessed, appropriately diagnosed, treated, and 

managed, and regularly reassessed with treatment adjusted as needed; 

‘‘(5) the role of credentialed pain management specialists and subspecialists, 

and of comprehensive interdisciplinary centers of treatment expertise; 

‘‘(6) the availability in the public, nonprofit, and private sectors of pain management-related information, services, and resources for consumers, employers, 

third-party payors, patients, their families, and caregivers, including information on— 

‘‘(A) appropriate assessment, diagnosis, treatment, and management options for all types of pain and pain-related symptoms; and 

‘‘(B) conditions for which no treatment options are yet recognized; and 

‘‘(7) other issues the Secretary deems appropriate. 

‘‘(c) CONSULTATION.—In designing and implementing the public awareness campaign required by this section, the Secretary shall consult with organizations representing patients in pain and other consumers, employers, physicians including 

physicians specializing in pain care, other pain management professionals, medical 

device manufacturers, and pharmaceutical companies. 

‘‘(d) COORDINATION.— 

‘‘(1) LEAD OFFICIAL.—The Secretary shall designate one official in the Department of Health and Human Services to oversee the campaign established under 

this section. 

‘‘(2) AGENCY COORDINATION.—The Secretary shall ensure the involvement in 

the public awareness campaign under this section of the Surgeon General of the 

Public Health Service, the Director of the Centers for Disease Control and Prevention, and such other representatives of offices and agencies of the Department of Health and Human Services as the Secretary determines appropriate. 

‘‘(e) UNDERSERVED AREAS AND POPULATIONS.—In designing the public awareness 

campaign under this section, the Secretary shall— 

‘‘(1) take into account the special needs of geographic areas and racial, ethnic, 

gender, age, and other demographic groups that are currently underserved; and 

‘‘(2) provide resources that will reduce disparities in access to appropriate diagnosis, assessment, and treatment. 

‘‘(f) GRANTS AND CONTRACTS.—The Secretary may make awards of grants, cooperative agreements, and contracts to public agencies and private nonprofit organizations to assist with the development and implementation of the public awareness 

campaign under this section. 

‘‘(g) EVALUATION AND REPORT.—Not later than the end of fiscal year 2011, the 

Secretary shall prepare and submit to the Congress a report evaluating the effectiveness of the public awareness campaign under this section in educating the general public with respect to the matters described in subsection (b). 

‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2009 and 

$4,000,000 for each of fiscal years 2010 and 2011.’’. 

PURPOSE AND SUMMARY

The purpose of H.R. 2994, the National Pain Care Policy Act of 

2007, is to amend the Public Health Service Act with respect to 

pain care. 

BACKGROUND AND NEED FOR LEGISLATION

Pain is the most common reason Americans access the health 

care system and is a leading cause of disability and major contributor to health care costs. The National Center for Health Statistics 

estimates that 76.2 million, or one in every four Americans, have 

suffered from pain that lasts longer than 24 hours and millions 

more suffer from acute pain. Most painful conditions can be relieved with proper treatment, and providing adequate pain management is a crucial component of improving and maintaining quality of life for patients, survivors, and their loved ones. People in 


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pain, however, often face significant barriers that can prevent proper assessment, diagnosis, treatment, and management of their 

pain. Left untreated, pain can decrease the quality of life and affect 

every aspect of daily living, including work, sleep, and social relations. 

HEARINGS

No hearings were held in connection with H.R. 2994. 

COMMITTEE CONSIDERATION

On Wednesday, September 17, 2008, the full Committee met in 

open markup session and ordered H.R. 2994 favorably reported to 

the House, amended, by a voice vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. No record votes were 

taken on amendments or in connection with ordering H.R. 2994 reported to the House. A motion by Mr. Dingell to order H.R. 2994 

favorably reported to the House, amended, was agreed to by a voice 

vote. 

COMMITTEE OVERSIGHT FINDINGS

Regarding clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the oversight findings of the Committee regarding H.R. 2994 are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The objective of H.R. 2994 is to amend the Public Health Service 

Act to (1) encourage the Secretary of Health and Human Services 

(HHS) to enter into an agreement with the Institute of Medicine 

(IOM) of the National Academies to convene a Conference on Pain; 

(2) encourage the Director of the National Institutes of Health 

(NIH) to continue to expand, through the Pain Consortium, an aggressive program of basic and clinical research on the causes of and 

potential treatments for pain; (3) establish an Interagency Pain Research Coordinating Committee within HHS; (4) allow the HHS 

Secretary to award grants, cooperative agreements, and contracts 

to health professions schools, hospices, and other public and private 

entities for the development and implementation of programs to 

provide education and training to health care professionals in pain 

care; and (5) require the HHS Secretary to establish and implement a national pain care education outreach and awareness campaign. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

Regarding compliance with clause 3(c)(2) of rule XIII of the Rules 

of the House of Representatives, the Committee finds that H.R. 

2994 would result in no new or increased budget authority, entitlement authority, or tax expenditures or revenues. 


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EARMARKS AND TAX AND TARIFF BENEFITS

Regarding compliance with clause 9 of rule XXI of the Rules of 

the House of Representatives, H.R. 2994 does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits 

as defined in clause 9(d), 9(e), or 9(f) of Rule XXI. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 2994 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate on H.R. 2994 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, September 22, 2008. 

Hon. JOHN D. DINGELL, 

Chairman, Committee on Energy and Commerce, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 2994, the National Pain 

Care Policy Act of 2008. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Stephanie Cameron. 

Sincerely, 

ROBERT A. SUNSHINE

(For Peter R. Orszag, Director). 

Enclosure. 

H.R. 2994—National Pain Care Policy Act of 2008 

Summary: H.R. 2994 would amend the Public Health Service Act 

to coordinate research programs related to pain, and require the 

Secretary of Health and Human Services (HHS) to convene a conference on pain and conduct a public awareness campaign on pain 

management. CBO estimates that enacting H.R. 2994 would cost 

$1 million in 2009 and $12 million over the 2009–2013 period, assuming appropriation of the necessary amounts. Enacting H.R. 

2994 would not affect direct spending or revenues. 

H.R. 2994 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA) 

and would impose no costs on state, local, or tribal governments. 

Estimated Cost to the Federal Government: The estimated cost 

of H.R. 2994 is shown in the following table. The costs of this legislation fall within budget function 550 (health). 


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By fiscal year in millions of dollars— 

2009 2010 2011 2012 2013 2009– 

2013 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Estimated Authorization Level .................................................................. 4 6 5 1 1 17 

Estimated Outlays .................................................................................... 1 4 5 1 1 12 

Basis of Estimate: H.R. 2994 would require the Secretary of HHS 

to convene a conference on pain, coordinate research programs related to pain, and conduct a public awareness campaign on pain 

management. For this estimate, CBO assumes that H.R. 2994 

would be enacted near the beginning of fiscal year 2009, that the 

necessary amounts will be appropriated each year, and that outlays 

will follow historical spending patterns for similar activities. CBO 

estimates that implementing H.R. 2994 would cost $12 million over 

the 2009–2013 period. 

Institute of Medicine conference on pain 

H.R. 2994 would require the Secretary of HHS to collaborate 

with the Institute of Medicine of the National Academies (or other 

appropriate entity) to convene a conference on pain. This bill would 

require the Secretary to complete a report summarizing the conference findings and recommendations to be submitted to the Congress not later than June 30, 2010. H.R. 2994 would authorize the 

appropriation of $0.5 million a year for fiscal years 2009 and 2010 

for those purposes. Assuming the appropriation of the specified 

amounts, CBO estimates that provision would cost $1 million over 

the 2009–2013 period. 

Pain research 

The bill would amend the Public Health Service Act to establish 

an interagency committee to coordinate pain research across federal agencies. Assuming the availability of appropriated funds, 

CBO estimates that provision would cost $4 million over the 2009– 

2013 time period. 

Public awareness campaign on pain management 

H.R. 2994 would direct the Secretary of HHS to conduct a nationwide campaign to increase public awareness of issues related to 

pain treatment and management. This bill would authorize the 

Secretary to award grants, cooperative agreements, and contracts 

to public agencies and private nonprofit organizations to assist 

with the development and implementation of the public awareness 

campaign. 

H.R. 2994 would authorize the appropriation of $2 million for fiscal years 2009 and $4 million a year for fiscal years 2010 and 2011 

for those activities. Assuming the appropriation of the authorized 

amounts, CBO estimates that implementing those provisions would 

cost $7 million over the 2009–2013 period. 

Intergovernmental and private-sector impact: H.R. 2994 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. Public institutions of higher education that provide education and training for health care professionals in pain care would 

benefit from grant funds authorized in the bill. 


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Estimate prepared by: Federal Costs: Stephanie Cameron and 

Kirstin Nelson; Impact on State, Local, and Tribal Governments: 

Lisa Ramirez-Branum; Impact on the Private Sector: Keisuke 

Nakagawa. 

Estimate approved by: Keith J. Fontenot, Deputy Assistant Director for Health and Human Resources, Budget Analysis Division. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 2994 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 2994. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the Constitutional authority for H.R. 2994 is provided in the provisions of Article I, section 8, clause 1, that relate to expending funds to provide for the 

general welfare of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 2994 does not relate to the terms 

and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act of 1995. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title; table of contents 

Section 1 establishes the short title of the bill as the National 

Pain Care Policy Act of 2008 and lists the table of contents. 

Section 2. Institute of Medicine Conference on Pain 

Section 2 states that, no later than June 30, 2009, the HHS Secretary must seek to enter into an agreement with the IOM of the 

National Academies to convene a Conference on Pain. The purpose 

of the Conference shall be to increase the recognition of pain as a 

significant public health problem in the United States; evaluate the 

adequacy of assessment, diagnosis, treatment, and management of 

acute and chronic pain in the general population; identify racial, 

ethnic, gender, age, and other demographic groups that may be disproportionately affected by inadequacies in the system; identify 

barriers to appropriate pain care; and establish an agenda for action in both the public and private sectors that will reduce such 

barriers and significantly improve the state of pain care research, 

education, and clinical care in the United States. 

If the Institute of Medicine declines to enter into this agreement, 

the HHS Secretary may enter into such agreement with another 

appropriate entity. 


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Section 2 requires that a report summarizing the Conference’s 

findings shall be submitted to Congress no later than June 30, 

2010. 

For the purpose of carrying out section 2, this legislation author- izes to be appropriated $500,000 for each of fiscal years 2009 and 

2010. 

Section 3. Pain research at National Institutes of Health 

Section 3 amends part B of title IV of the Public Health Service 

Act (42 U.S.C. 284 et seq.) by adding a new section which encourages the NIH Director to continue and expand, through the Pain 

Consortium, an aggressive program of basic and clinical research 

on the causes of and potential treatments for pain. At least once 

a year, the Pain Consortium, in consultation with the Division of 

Program Coordination, Planning, and Strategic Initiatives, shall 

develop and submit to the NIH Director recommendations on appropriate pain research initiatives that could be undertaken with 

funds reserved for the Common Fund or otherwise available for 

such initiatives. 

Section 3 defines the term ‘‘Pain Consortium’’ to mean the Pain 

Consortium of NIH or a similar trans-NIH coordinating entity designated by the Secretary. 

Section 3 directs the Secretary to establish an Interagency Pain 

Research Coordinating Committee, charged with coordinating all 

efforts within HHS and other Federal agencies that relate to pain 

research. Section 3 establishes the composition of the Coordinating 

Committee and requires that the Committee meet at the call of the 

chairperson, or upon the request of the NIH Director, but in no 

case less often than once per year. 

Section 3 establishes the duties of the Coordinating Committee 

and requires the Committee to develop a summary of advances in 

pain care research supported or conducted by the Federal agencies 

relevant to the diagnosis, treatment, and prevention of pain, and 

diseases and disorders associated with pain; identify critical gaps 

in basic and clinical research on the symptoms and causes of pain; 

and make recommendations. The Secretary shall review the necessity of the Committee at least once every two years. 

Section 4. Pain care education and training 

Section 4 amends part D of title VII of the Public Health Service 

Act (42 U.S.C. 294 et seq.) by adding a new section which states 

that the Secretary may award grants, cooperative agreements, and 

contracts to health professions schools, hospices, and other public 

and private entities for the development and implementation of 

programs to provide education and training to health care professionals in pain care. 

Section 4 states that an award may be made only if the applicant 

for the award agrees that the program carried out with the award 

will include information and education on recognized means for assessing, diagnosing, treating, and managing pain and related signs 

and symptoms, including the medically appropriate use of controlled substances. In addition, programs carried out must include 

information and education on applicable laws, regulations, rules, 

and policies on controlled substances; interdisciplinary approaches 

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graphic, and other barriers to care in underserved populations; and 

recent findings, developments, and improvements in the provision 

of pain care. The Secretary shall provide for the evaluation of these 

programs in order to determine the effect of such programs on the 

knowledge and practice of pain care. 

Section 4 defines the term ‘‘pain care’’ to mean the assessment, 

diagnosis, treatment, or management of acute or chronic pain regardless of causation or body location. 

Section 4 updates the existing authorization of appropriations to 

require that, of the amounts appropriated for a fiscal year, the Secretary shall make available not less than $5,000,000 for awards of 

grants, cooperative agreements, and contracts. 

Section 5. Public awareness campaign on pain management 

Section 5 amends part B of title II of the Public Health Service 

Act (42 U.S.C. 238 et seq.) by adding a new section which requires 

that, no later than June 30, 2009, the Secretary shall establish and 

implement a national pain care education outreach and awareness 

campaign. Amongst other things, the public awareness campaign 

shall be designed to educate consumers, patients, their families, 

and other caregivers with respect to the incidence and importance 

of pain as a national public health problem. In designing and implementing the public awareness campaign, the Secretary shall 

consult with organizations representing patients in pain and other 

consumers, employers, physicians, other pain management professionals, medical device manufacturers, and pharmaceutical companies. 

The Secretary shall designate one official in HHS to oversee the 

public awareness campaign and the Secretary shall ensure the involvement of the Surgeon General of the Public Health Service, the 

Director of the Centers for Disease Control and Prevention, and 

other such representatives of offices and agencies of HHS as the 

Secretary determines appropriate. 

Section 5 requires that, in designing the public awareness campaign, the Secretary shall take into account the special needs of geographic areas and racial, ethnic, gender, age, and other demographic groups that are currently underserved and provide resources that will reduce disparities in access to appropriate diagnosis, assessment, and treatment. 

Under this section, the Secretary may make awards of grants, cooperative agreements, and contracts to public agencies and private 

nonprofit organizations to assist with the development and implementation of the public awareness campaign. In addition, the Secretary shall prepare and submit a report to Congress evaluating 

the effectiveness of the public awareness campaign in educating 

the general public. 

For purposes of carrying out this section, Section 5 authorizes 

there to be appropriated $2,000,000 for fiscal year 2009 and 

$4,000,000 for each of fiscal years 2010 and 2011. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitVerDate Aug 31 2005 02:05 Sep 29, 2008 Jkt 069006 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\HR871.XXX HR871

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ted is enclosed in black brackets, new matter is printed in italic, 

existing law in which no change is proposed is shown in roman): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE II—ADMINISTRATION AND MISCELLANEOUS 

PROVISIONS 

* * * * * * * 

PART B—MISCELLANEOUS PROVISIONS

* * * * * * * 

SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN MANAGEMENT. 

(a) ESTABLISHMENT.—Not later than June 30, 2009, the Secretary 

shall establish and implement a national pain care education outreach and awareness campaign described in subsection (b). 

(b) REQUIREMENTS.—The Secretary shall design the public awareness campaign under this section to educate consumers, patients, 

their families, and other caregivers with respect to— 

(1) the incidence and importance of pain as a national public 

health problem; 

(2) the adverse physical, psychological, emotional, societal, 

and financial consequences that can result if pain is not appropriately assessed, diagnosed, treated, or managed; 

(3) the availability, benefits, and risks of all pain treatment 

and management options; 

(4) having pain promptly assessed, appropriately diagnosed, 

treated, and managed, and regularly reassessed with treatment 

adjusted as needed; 

(5) the role of credentialed pain management specialists and 

subspecialists, and of comprehensive interdisciplinary centers of 

treatment expertise; 

(6) the availability in the public, nonprofit, and private sectors of pain management-related information, services, and resources for consumers, employers, third-party payors, patients, 

their families, and caregivers, including information on— 

(A) appropriate assessment, diagnosis, treatment, and 

management options for all types of pain and pain-related 

symptoms; and 

(B) conditions for which no treatment options are yet recognized; and 

(7) other issues the Secretary deems appropriate. 

(c) CONSULTATION.—In designing and implementing the public 

awareness campaign required by this section, the Secretary shall 

consult with organizations representing patients in pain and other 

consumers, employers, physicians including physicians specializing 

in pain care, other pain management professionals, medical device 

manufacturers, and pharmaceutical companies. 

(d) COORDINATION.— 

(1) LEAD OFFICIAL.—The Secretary shall designate one official 

in the Department of Health and Human Services to oversee the 

campaign established under this section. 


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(2) AGENCY COORDINATION.—The Secretary shall ensure the 

involvement in the public awareness campaign under this section of the Surgeon General of the Public Health Service, the 

Director of the Centers for Disease Control and Prevention, and 

such other representatives of offices and agencies of the Department of Health and Human Services as the Secretary determines appropriate. 

(e) UNDERSERVED AREAS AND POPULATIONS.—In designing the 

public awareness campaign under this section, the Secretary shall— 

(1) take into account the special needs of geographic areas 

and racial, ethnic, gender, age, and other demographic groups 

that are currently underserved; and 

(2) provide resources that will reduce disparities in access to 

appropriate diagnosis, assessment, and treatment. 

(f) GRANTS AND CONTRACTS.—The Secretary may make awards of 

grants, cooperative agreements, and contracts to public agencies and 

private nonprofit organizations to assist with the development and 

implementation of the public awareness campaign under this section. 

(g) EVALUATION AND REPORT.—Not later than the end of fiscal 

year 2011, the Secretary shall prepare and submit to the Congress 

a report evaluating the effectiveness of the public awareness campaign under this section in educating the general public with respect to the matters described in subsection (b). 

(h) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out this section, there are authorized to be appropriated 

$2,000,000 for fiscal year 2009 and $4,000,000 for each of fiscal 

years 2010 and 2011. 

* * * * * * * 

TITLE IV—NATIONAL RESEARCH INSTITUTES 

* * * * * * * 

PART B—GENERAL PROVISIONS RESPECTING NATIONAL RESEARCH

INSTITUTES

* * * * * * * 

SEC. 409J. PAIN RESEARCH. 

(a) RESEARCH INITIATIVES.— 

(1) IN GENERAL.—The Director of NIH is encouraged to continue and expand, through the Pain Consortium, an aggressive 

program of basic and clinical research on the causes of and potential treatments for pain. 

(2) ANNUAL RECOMMENDATIONS.—Not less than annually, the 

Pain Consortium, in consultation with the Division of Program 

Coordination, Planning, and Strategic Initiatives, shall develop 

and submit to the Director of NIH recommendations on appropriate pain research initiatives that could be undertaken with 

funds reserved under section 402A(c)(1) for the Common Fund 

or otherwise available for such initiatives. 

(3) DEFINITION.—In this subsection, the term ‘‘Pain Consortium’’ means the Pain Consortium of the National Institutes of 

Health or a similar trans-National Institutes of Health coordiVerDate Aug 31 2005 02:05 Sep 29, 2008 Jkt 069006 PO 00000 Frm 00013 Fmt 6659 Sfmt 6603 E:\HR\OC\HR871.XXX HR871

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nating entity designated by the Secretary for purposes of this 

subsection. 

(b) INTERAGENCY PAIN RESEARCH COORDINATING COMMITTEE.— (1) ESTABLISHMENT.—The Secretary shall establish not later 

than 1 year after the date of the enactment of this section and 

as necessary maintain a committee, to be known as the Interagency Pain Research Coordinating Committee (in this section 

referred to as the ‘‘Committee’’), to coordinate all efforts within 

the Department of Health and Human Services and other Federal agencies that relate to pain research. 

(2) MEMBERSHIP.— (A) IN GENERAL.—The Committee shall be composed of 

the following voting members: 

(i) Not more than 7 voting Federal representatives as 

follows: 

(I) The Director of the Centers for Disease Control and Prevention. 

(II) The Director of the National Institutes of 

Health and the directors of such national research 

institutes and national centers as the Secretary determines appropriate. 

(III) The heads of such other agencies of the Department of Health and Human Services as the 

Secretary determines appropriate. 

(IV) Representatives of other Federal agencies 

that conduct or support pain care research and 

treatment, including the Department of Defense 

and the Department of Veterans Affairs. 

(ii) 12 additional voting members appointed under 

subparagraph (B). 

(B) ADDITIONAL MEMBERS.—The Committee shall include 

additional voting members appointed by the Secretary as 

follows: 

(i) 6 members shall be appointed from among scientists, physicians, and other health professionals, 

who— 

(I) are not officers or employees of the United 

States; 

(II) represent multiple disciplines, including 

clinical, basic, and public health sciences; 

(III) represent different geographical regions of 

the United States; and 

(IV) are from practice settings, academia, manufacturers or other research settings; and 

(ii) 6 members shall be appointed from members of 

the general public, who are representatives of leading 

research, advocacy, and service organizations for individuals with pain-related conditions 

(C) NONVOTING MEMBERS.—The Committee shall include 

such nonvoting members as the Secretary determines to be 

appropriate. 

(3) CHAIRPERSON.—The voting members of the Committee 

shall select a chairperson from among such members. The selection of a chairperson shall be subject to the approval of the Director of NIH. 


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(4) MEETINGS.—The Committee shall meet at the call of the 

chairperson of the Committee or upon the request of the Director 

of NIH, but in no case less often than once each year. 

(5) DUTIES.—The Committee shall— 

(A) develop a summary of advances in pain care research 

supported or conducted by the Federal agencies relevant to 

the diagnosis, prevention, and treatment of pain and diseases and disorders associated with pain; 

(B) identify critical gaps in basic and clinical research on 

the symptoms and causes of pain; 

(C) make recommendations to ensure that the activities of 

the National Institutes of Health and other Federal agencies, including the Department of Defense and the Department of Veteran Affairs, are free of unnecessary duplication 

of effort; 

(D) make recommendations on how best to disseminate 

information on pain care; and 

(E) make recommendations on how to expand partnerships between public entities, including Federal agencies, 

and private entities to expand collaborative, cross-cutting 

research. 

(6) REVIEW.—The Secretary shall review the necessity of the 

Committee at least once every 2 years. 

* * * * * * * 

TITLE VII—HEALTH PROFESSIONS 

EDUCATION 

* * * * * * * 

PART D—INTERDISCIPLINARY, COMMUNITYBASED LINKAGES 

* * * * * * * 

SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE. 

(a) IN GENERAL.—The Secretary may make awards of grants, cooperative agreements, and contracts to health professions schools, 

hospices, and other public and private entities for the development 

and implementation of programs to provide education and training 

to health care professionals in pain care. 

(b) PRIORITIES.—In making awards under subsection (a), the Secretary shall give priority to awards for the implementation of programs under such subsection. 

(c) CERTAIN TOPICS.—An award may be made under subsection 

(a) only if the applicant for the award agrees that the program carried out with the award will include information and education 

on— 

(1) recognized means for assessing, diagnosing, treating, and 

managing pain and related signs and symptoms, including the 

medically appropriate use of controlled substances; 

(2) applicable laws, regulations, rules, and policies on controlled substances, including the degree to which misconceptions and concerns regarding such laws, regulations, rules, and 


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policies, or the enforcement thereof, may create barriers to patient access to appropriate and effective pain care; 

(3) interdisciplinary approaches to the delivery of pain care, 

including delivery through specialized centers providing comprehensive pain care treatment expertise; 

(4) cultural, linguistic, literacy, geographic, and other barriers to care in underserved populations; and 

(5) recent findings, developments, and improvements in the 

provision of pain care. 

(d) PROGRAM SITES.—Education and training under subsection 

(a) may be provided at or through health professions schools, residency training programs, and other graduate programs in the 

health professions; entities that provide continuing education in 

medicine, pain management, dentistry, psychology, social work, 

nursing, and pharmacy; hospices; and such other programs or sites 

as the Secretary determines to be appropriate. 

(e) EVALUATION OF PROGRAMS.—The Secretary shall (directly or 

through grants or contracts) provide for the evaluation of programs 

implemented under subsection (a) in order to determine the effect of 

such programs on knowledge and practice of pain care. 

(f) PEER REVIEW GROUPS.—In carrying out section 799(f) with respect to this section, the Secretary shall ensure that the membership 

of each peer review group involved includes individuals with expertise and experience in pain care. 

(g) DEFINITIONS.—For purposes of this section the term ‘‘pain 

care’’ means the assessment, diagnosis, treatment, or management of 

acute or chronic pain regardless of causation or body location. 

SEC. ø754.¿ 755. QUENTIN N. BURDICK PROGRAM FOR RURAL INTERDISCIPLINARY TRAINING. 

(a) * * * 

* * * * * * * 

SEC. ø755.¿ 756. ALLIED HEALTH AND OTHER DISCIPLINES. 

(a) * * * 

* * * * * * * 

SEC. ø756.¿ 757. ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES. 

(a) * * * 

* * * * * * * 

(b) COMPOSITION.— 

(1) * * * 

* * * * * * * 

(2) APPOINTMENT.—Not later than 90 days after the date of 

enactment of this Act, the Secretary shall appoint the members 

of the Advisory Committee from among individuals who are 

health professionals from schools of the types described in sections 751(a)(1)(A), 751(a)(1)(B), 753(b), ø754(3)(A), and 755(b)¿ 

755(3)(A), and 756(b). In making such appointments, the Secretary shall ensure a fair balance between the health professions, that at least 75 percent of the members of the Advisory 

Committee are health professionals, a broad geographic representation of members and a balance between urban and 

rural members. Members shall be appointed based on their 


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competence, interest, and knowledge of the mission of the profession involved. 

* * * * * * * 

SEC. ø757.¿ 758. AUTHORIZATION OF APPROPRIATIONS. 

(a) * * * 

(b) ALLOCATION.— (1) IN GENERAL.—Of the amounts appropriated under subsection (a) for a fiscal year, the Secretary shall make available— 

(A) * * * 

* * * * * * * 

(B) not less than $3,765,000 for awards of grants and 

contracts under section 752, of which not less than 50 percent of such amount shall be made available for centers 

described in subsection (a)(1) of such section; øand¿ 

(C) not less than $22,631,000 for awards of grants and 

contracts under sections 753, ø754, and 755.¿ 755, and 

756; and 

(D) not less than $5,000,000 for awards of grants, cooperative agreements, and contracts under sections 754. 

* * * * * * * 

SEC. ø758.¿ 759. INTERDISCIPLINARY TRAINING AND EDUCATION ON 

DOMESTIC VIOLENCE AND OTHER TYPES OF VIOLENCE 

AND ABUSE. 

(a) * * * 

* * * * * * * 

Æ 


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