I 

111TH CONGRESS 

1ST SESSION H. R. 756 

To amend the Public Health Service Act with respect to pain care. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 28, 2009 

Mrs. CAPPS (for herself and Mr. ROGERS of Michigan) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act with respect to 

pain care. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘National Pain Care Policy Act of 2009’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 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. 


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1 SEC. 2. INSTITUTE OF MEDICINE CONFERENCE ON PAIN. 

2 (a) CONVENING.—Not later than June 30, 2010, the 

3 Secretary of Health and Human Services shall seek to 

4 enter into an agreement with the Institute of Medicine of 

5 the National Academies to convene a Conference on Pain 

6 (in this section referred to as ‘‘the Conference’’). 

7 (b) PURPOSES.—The purposes of the Conference 

8 shall be to— 

9 (1) increase the recognition of pain as a signifi10 cant public health problem in the United States; 

11 (2) evaluate the adequacy of assessment, diag12 nosis, treatment, and management of acute and 

13 chronic pain in the general population, and in identi14 fied racial, ethnic, gender, age, and other demo15 graphic groups that may be disproportionately af16 fected by inadequacies in the assessment, diagnosis, 

17 treatment, and management of pain; 

18 (3) identify barriers to appropriate pain care, 

19 including— 

20 (A) lack of understanding and education 

21 among employers, patients, health care pro22 viders, regulators, and third-party payors; 

23 (B) barriers to access to care at the pri24 mary, specialty, and tertiary care levels, includ25 ing barriers— 


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1 (i) specific to those populations that 

2 are disproportionately undertreated for 

3 pain; 

4 (ii) related to physician concerns over 

5 regulatory and law enforcement policies 

6 applicable to some pain therapies; and 

7 (iii) attributable to benefit, coverage, 

8 and payment policies in both the public 

9 and private sectors; and 

10 (C) gaps in basic and clinical research on 

11 the symptoms and causes of pain, and potential 

12 assessment methods and new treatments to im13 prove pain care; and 

14 (4) establish an agenda for action in both the 

15 public and private sectors that will reduce such bar16 riers and significantly improve the state of pain care 

17 research, education, and clinical care in the United 

18 States. 

19 (c) OTHER APPROPRIATE ENTITY.—If the Institute 

20 of Medicine declines to enter into an agreement under sub21 section (a), the Secretary of Health and Human Services 

22 may enter into such agreement with another appropriate 

23 entity. 


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1 (d) REPORT.—A report summarizing the Con2 ference’s findings and recommendations shall be sub3 mitted to the Congress not later than June 30, 2011. 

4 (e) AUTHORIZATION OF APPROPRIATIONS.—For the 

5 purpose of carrying out this section, there is authorized 

6 to be appropriated $500,000 for each of fiscal years 2010 

7 and 2011. 

8 SEC. 3. PAIN RESEARCH AT NATIONAL INSTITUTES OF 

9 HEALTH. 

10 Part B of title IV of the Public Health Service Act 

11 (42 U.S.C. 284 et seq.) is amended by adding at the end 

12 the following: 

13 ‘‘SEC. 409J. PAIN RESEARCH. 

14 ‘‘(a) RESEARCH INITIATIVES.— 

15 ‘‘(1) IN GENERAL.—The Director of NIH is en16 couraged to continue and expand, through the Pain 

17 Consortium, an aggressive program of basic and 

18 clinical research on the causes of and potential treat19 ments for pain. 

20 ‘‘(2) ANNUAL RECOMMENDATIONS.—Not less 

21 than annually, the Pain Consortium, in consultation 

22 with the Division of Program Coordination, Plan23 ning, and Strategic Initiatives, shall develop and 

24 submit to the Director of NIH recommendations on 

25 appropriate pain research initiatives that could be 


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1 undertaken with funds reserved under section 

2 402A(c)(1) for the Common Fund or otherwise 

3 available for such initiatives. 

4 ‘‘(3) DEFINITION.—In this subsection, the term 

5 ‘Pain Consortium’ means the Pain Consortium of 

6 the National Institutes of Health or a similar trans7 National Institutes of Health coordinating entity 

8 designated by the Secretary for purposes of this sub9 section. 

10 ‘‘(b) INTERAGENCY PAIN RESEARCH COORDINATING

11 COMMITTEE.— 

12 ‘‘(1) ESTABLISHMENT.—The Secretary shall es13 tablish not later than 1 year after the date of the 

14 enactment of this section and as necessary maintain 

15 a committee, to be known as the Interagency Pain 

16 Research Coordinating Committee (in this section 

17 referred to as the ‘Committee’), to coordinate all ef18 forts within the Department of Health and Human 

19 Services and other Federal agencies that relate to 

20 pain research. 

21 ‘‘(2) MEMBERSHIP.— 

22 ‘‘(A) IN GENERAL.—The Committee shall 

23 be composed of the following voting members: 

24 ‘‘(i) Not more than 7 voting Federal 

25 representatives as follows: 


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1 ‘‘(I) The Director of the Centers 

2 for Disease Control and Prevention. 

3 ‘‘(II) The Director of the Na4 tional Institutes of Health and the di5 rectors of such national research insti6 tutes and national centers as the Sec7 retary determines appropriate. 

8 ‘‘(III) The heads of such other 

9 agencies of the Department of Health 

10 and Human Services as the Secretary 

11 determines appropriate. 

12 ‘‘(IV) Representatives of other 

13 Federal agencies that conduct or sup14 port pain care research and treat15 ment, including the Department of 

16 Defense and the Department of Vet17 erans Affairs. 

18 ‘‘(ii) 12 additional voting members ap19 pointed under subparagraph (B). 

20 ‘‘(B) ADDITIONAL MEMBERS.—The Com21 mittee shall include additional voting members 

22 appointed by the Secretary as follows: 

23 ‘‘(i) 6 members shall be appointed 

24 from among scientists, physicians, and 

25 other health professionals, who— 


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1 ‘‘(I) are not officers or employees 

2 of the United States; 

3 ‘‘(II) represent multiple dis4 ciplines, including clinical, basic, and 

5 public health sciences; 

6 ‘‘(III) represent different geo7 graphical regions of the United 

8 States; and 

9 ‘‘(IV) are from practice settings, 

10 academia, manufacturers or other re11 search settings; and 

12 ‘‘(ii) 6 members shall be appointed 

13 from members of the general public, who 

14 are representatives of leading research, ad15 vocacy, and service organizations for indi16 viduals with pain-related conditions. 

17 ‘‘(C) NONVOTING MEMBERS.—The Com18 mittee shall include such nonvoting members as 

19 the Secretary determines to be appropriate. 

20 ‘‘(3) CHAIRPERSON.—The voting members of 

21 the Committee shall select a chairperson from 

22 among such members. The selection of a chairperson 

23 shall be subject to the approval of the Director of 

24 NIH. 


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1 ‘‘(4) MEETINGS.—The Committee shall meet at 

2 the call of the chairperson of the Committee or upon 

3 the request of the Director of NIH, but in no case 

4 less often than once each year. 

5 ‘‘(5) DUTIES.—The Committee shall— 

6 ‘‘(A) develop a summary of advances in 

7 pain care research supported or conducted by 

8 the Federal agencies relevant to the diagnosis, 

9 prevention, and treatment of pain and diseases 

10 and disorders associated with pain; 

11 ‘‘(B) identify critical gaps in basic and 

12 clinical research on the symptoms and causes of 

13 pain; 

14 ‘‘(C) make recommendations to ensure that 

15 the activities of the National Institutes of 

16 Health and other Federal agencies, including 

17 the Department of Defense and the Department 

18 of Veteran Affairs, are free of unnecessary du19 plication of effort; 

20 ‘‘(D) make recommendations on how best 

21 to disseminate information on pain care; and 

22 ‘‘(E) make recommendations on how to ex23 pand partnerships between public entities, in24 cluding Federal agencies, and private entities to 

25 expand collaborative, cross-cutting research. 


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1 ‘‘(6) REVIEW.—The Secretary shall review the 

2 necessity of the Committee at least once every 2 

3 years.’’. 

4 SEC. 4. PAIN CARE EDUCATION AND TRAINING. 

5 (a) PAIN CARE EDUCATION AND TRAINING.—Part D 

6 of title VII of the Public Health Service Act (42 U.S.C. 

7 294 et seq.) is amended— 

8 (1) by redesignating sections 754 through 758 

9 as sections 755 through 759, respectively; and 

10 (2) by inserting after section 753 the following: 

11 ‘‘SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN 

12 PAIN CARE. 

13 ‘‘(a) IN GENERAL.—The Secretary may make awards 

14 of grants, cooperative agreements, and contracts to health 

15 professions schools, hospices, and other public and private 

16 entities for the development and implementation of pro17 grams to provide education and training to health care 

18 professionals in pain care. 

19 ‘‘(b) PRIORITIES.—In making awards under sub20 section (a), the Secretary shall give priority to awards for 

21 the implementation of programs under such subsection. 

22 ‘‘(c) CERTAIN TOPICS.—An award may be made 

23 under subsection (a) only if the applicant for the award 

24 agrees that the program carried out with the award will 

25 include information and education on— 


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1 ‘‘(1) recognized means for assessing, diag2 nosing, treating, and managing pain and related 

3 signs and symptoms, including the medically appro4 priate use of controlled substances; 

5 ‘‘(2) applicable laws, regulations, rules, and 

6 policies on controlled substances, including the de7 gree to which misconceptions and concerns regarding 

8 such laws, regulations, rules, and policies, or the en9 forcement thereof, may create barriers to patient ac10 cess to appropriate and effective pain care; 

11 ‘‘(3) interdisciplinary approaches to the delivery 

12 of pain care, including delivery through specialized 

13 centers providing comprehensive pain care treatment 

14 expertise; 

15 ‘‘(4) cultural, linguistic, literacy, geographic, 

16 and other barriers to care in underserved popu17 lations; and 

18 ‘‘(5) recent findings, developments, and im19 provements in the provision of pain care. 

20 ‘‘(d) PROGRAM SITES.—Education and training 

21 under subsection (a) may be provided at or through health 

22 professions schools, residency training programs, and 

23 other graduate programs in the health professions; entities 

24 that provide continuing education in medicine, pain man25 agement, dentistry, psychology, social work, nursing, and 


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1 pharmacy; hospices; and such other programs or sites as 

2 the Secretary determines to be appropriate. 

3 ‘‘(e) EVALUATION OF PROGRAMS.—The Secretary 

4 shall (directly or through grants or contracts) provide for 

5 the evaluation of programs implemented under subsection 

6 (a) in order to determine the effect of such programs on 

7 knowledge and practice of pain care. 

8 ‘‘(f) PEER REVIEW GROUPS.—In carrying out section 

9 799(f) with respect to this section, the Secretary shall en10 sure that the membership of each peer review group in11 volved includes individuals with expertise and experience 

12 in pain care. 

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

14 term ‘pain care’ means the assessment, diagnosis, treat15 ment, or management of acute or chronic pain regardless 

16 of causation or body location.’’. 

17 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

18 758(b)(1) of the Public Health Service Act (as redesig19 nated by subsection (a)(1) of this section) is amended— 

20 (1) by striking ‘‘and’’ at the end of subpara21 graph (B); 

22 (2) by striking the period at the end of sub23 paragraph (C) and inserting ‘‘; and’’; and 

24 (3) by inserting after subparagraph (C) the fol25 lowing: 


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1 ‘‘(D) not less than $5,000,000 for awards 

2 of grants, cooperative agreements, and con3 tracts under sections 754.’’. 

4 (c) TECHNICAL AMENDMENTS.—Title VII of the 

5 Public Health Service Act (42 U.S.C. 292 et seq.) is 

6 amended— 

7 (1) in paragraph (2) of section 757(b) (as re8 designated by subsection (a)(1)), by striking 

9 ‘‘754(3)(A), and 755(b)’’ and inserting ‘‘755(3)(A), 

10 and 756(b)’’; and 

11 (2) in subparagraph (C) of section 758(b)(1) 

12 (as redesignated by subsection (a)(1)), by striking 

13 ‘‘754, and 755’’ and inserting ‘‘755, and 756’’. 

14 SEC. 5. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGE15 MENT. 

16 Part B of title II of the Public Health Service Act 

17 (42 U.S.C. 238 et seq.) is amended by adding at the end 

18 the following: 

19 ‘‘SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARE20 NESS CAMPAIGN ON PAIN MANAGEMENT. 

21 ‘‘(a) ESTABLISHMENT.—Not later than June 30, 

22 2010, the Secretary shall establish and implement a na23 tional pain care education outreach and awareness cam24 paign described in subsection (b). 


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1 ‘‘(b) REQUIREMENTS.—The Secretary shall design 

2 the public awareness campaign under this section to edu3 cate consumers, patients, their families, and other care4 givers with respect to— 

5 ‘‘(1) the incidence and importance of pain as a 

6 national public health problem; 

7 ‘‘(2) the adverse physical, psychological, emo8 tional, societal, and financial consequences that can 

9 result if pain is not appropriately assessed, diag10 nosed, treated, or managed; 

11 ‘‘(3) the availability, benefits, and risks of all 

12 pain treatment and management options; 

13 ‘‘(4) having pain promptly assessed, appro14 priately diagnosed, treated, and managed, and regu15 larly reassessed with treatment adjusted as needed; 

16 ‘‘(5) the role of credentialed pain management 

17 specialists and subspecialists, and of comprehensive 

18 interdisciplinary centers of treatment expertise; 

19 ‘‘(6) the availability in the public, nonprofit, 

20 and private sectors of pain management-related in21 formation, services, and resources for consumers, 

22 employers, third-party payors, patients, their fami23 lies, and caregivers, including information on— 


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1 ‘‘(A) appropriate assessment, diagnosis, 

2 treatment, and management options for all 

3 types of pain and pain-related symptoms; and 

4 ‘‘(B) conditions for which no treatment op5 tions are yet recognized; and 

6 ‘‘(7) other issues the Secretary deems appro7 priate. 

8 ‘‘(c) CONSULTATION.—In designing and imple9 menting the public awareness campaign required by this 

10 section, the Secretary shall consult with organizations rep11 resenting patients in pain and other consumers, employ12 ers, physicians including physicians specializing in pain 

13 care, other pain management professionals, medical device 

14 manufacturers, and pharmaceutical companies. 

15 ‘‘(d) COORDINATION.— 

16 ‘‘(1) LEAD OFFICIAL.—The Secretary shall des17 ignate one official in the Department of Health and 

18 Human Services to oversee the campaign established 

19 under this section. 

20 ‘‘(2) AGENCY COORDINATION.—The Secretary 

21 shall ensure the involvement in the public awareness 

22 campaign under this section of the Surgeon General 

23 of the Public Health Service, the Director of the 

24 Centers for Disease Control and Prevention, and 

25 such other representatives of offices and agencies of 


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1 the Department of Health and Human Services as 

2 the Secretary determines appropriate. 

3 ‘‘(e) UNDERSERVED AREAS AND POPULATIONS.—In 

4 designing the public awareness campaign under this sec5 tion, the Secretary shall— 

6 ‘‘(1) take into account the special needs of geo7 graphic areas and racial, ethnic, gender, age, and 

8 other demographic groups that are currently under9 served; and 

10 ‘‘(2) provide resources that will reduce dispari11 ties in access to appropriate diagnosis, assessment, 

12 and treatment. 

13 ‘‘(f) GRANTS AND CONTRACTS.—The Secretary may 

14 make awards of grants, cooperative agreements, and con15 tracts to public agencies and private nonprofit organiza16 tions to assist with the development and implementation 

17 of the public awareness campaign under this section. 

18 ‘‘(g) EVALUATION AND REPORT.—Not later than the 

19 end of fiscal year 2012, the Secretary shall prepare and 

20 submit to the Congress a report evaluating the effective21 ness of the public awareness campaign under this section 

22 in educating the general public with respect to the matters 

23 described in subsection (b). 

24 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For 

25 purposes of carrying out this section, there are authorized 


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1 to be appropriated $2,000,000 for fiscal year 2010 and 

2 $4,000,000 for each of fiscal years 2011 and 2012.’’. 

Æ 


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