II 

110TH CONGRESS 

2D SESSION S. 3387 

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

IN THE SENATE OF THE UNITED STATES 

JULY 31, 2008 

Mr. HATCH (for himself and Mr. DODD) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

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 2008’’. 

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. Findings. 

Sec. 3. Institute of Medicine Conference on Pain. 

Sec. 4. Pain Consortium at National Institutes of Health. 

Sec. 5. Pain care education and training. 

Sec. 6. Public awareness campaign on pain management. 


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1 SEC. 2. FINDINGS. 

2 The Congress finds that— 

3 (1) pain is the most common reason Americans 

4 access the health care system and is a leading con5 tributor to health care costs; 

6 (2) most painful conditions can be relieved with 

7 proper treatment, and providing adequate pain man8 agement is a crucial component of improving and 

9 maintaining quality of life for patients, survivors, 

10 and their loved ones; 

11 (3) pain is a leading cause of lost productivity, 

12 temporary disability, and permanent disability in the 

13 American workforce; 

14 (4) pain affects Americans across all ages, in15 cluding children. It can occur at any stage of dis16 ease, affecting patients in active treatment, survivors 

17 who have completed treatment, and those at the end 

18 of life; 

19 (5) in some cases pain is the disease itself and 

20 in others it is caused by or related to other diseases 

21 and conditions; 

22 (6) either acute or chronic pain may accompany 

23 other health conditions that are prevalent in the 

24 Medicare and Medicaid populations, including can25 cer, arthritis, diabetes, and cardiovascular disease; 


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1 (7) pain is often improperly assessed, 

2 misdiagnosed, mistreated, or undertreated; 

3 (8) disparities in the assessment, diagnosis, and 

4 treatment of pain across racial and ethnic groups, 

5 particularly at the end of life, are well documented; 

6 (9) pain research funding represents less than 

7 2 percent of the annual research expenditures of the 

8 National Institutes of Health; 

9 (10) pain research needs better planning and 

10 coordination across the many institutes, centers, and 

11 programs of the National Institutes of Health; 

12 (11) many health care professionals are inad13 equately trained in the proper assessment, diagnosis, 

14 treatment, and management of pain; 

15 (12) patients in pain face significant barriers 

16 that can prevent proper assessment, diagnosis, treat17 ment, and management of their pain; and 

18 (13) improving pain care research, education, 

19 access, and care are national health care priorities of 

20 the United States. 

21 SEC. 3. INSTITUTE OF MEDICINE CONFERENCE ON PAIN. 

22 (a) CONVENING.—Not later than June 30, 2009, the 

23 Secretary of Health and Human Services shall seek to 

24 enter an agreement with the Institute of Medicine of the 


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1 National Academies to convene a Conference on Pain (in 

2 this section referred to as ‘‘the Conference’’). 

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

4 shall be to— 

5 (1) increase the recognition of pain as a signifi6 cant public health problem in the United States; 

7 (2) evaluate the adequacy of assessment, diag8 nosis, treatment, and management of acute and 

9 chronic pain in the general population, and in identi10 fied racial, ethnic, gender, age, and other demo11 graphic groups that may be disproportionately af12 fected by inadequacies in the assessment, diagnosis, 

13 treatment, and management of pain; 

14 (3) identify barriers to appropriate pain care, 

15 including— 

16 (A) lack of understanding and education 

17 among employers, patients, health care pro18 viders, regulators, and third-party payors; 

19 (B) barriers to access to care at the pri20 mary, specialty, and tertiary care levels, includ21 ing barriers— 

22 (i) specific to those populations that 

23 are disproportionately undertreated for 

24 pain; 


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1 (ii) related to physician concerns over 

2 regulatory and law enforcement policies 

3 applicable to some pain therapies; and 

4 (iii) attributable to benefit, coverage, 

5 and payment policies in both the public 

6 and private sectors; and 

7 (C) gaps in basic and clinical research on 

8 the symptoms and causes of pain, and potential 

9 assessment methods and new treatments to im10 prove pain care; and 

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

12 public and private sectors that will reduce such bar13 riers and significantly improve the state of pain care 

14 research, education, and clinical care in the United 

15 States. 

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

17 of Medicine declines to enter into an agreement under sub18 section (a), the Secretary of Health and Human Services 

19 may enter into such agreement with another appropriate 

20 entity. 

21 (d) REPORT.—A report summarizing the Con22 ference’s findings and recommendations shall be sub23 mitted to the Congress not later than June 30, 2010. 

24 (e) AUTHORIZATION OF APPROPRIATIONS.—For the 

25 purpose of carrying out this section, there are authorized 


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1 to be appropriated such sums as may be necessary for fis2 cal years 2009 and 2010. 

3 SEC. 4. PAIN CONSORTIUM AT NATIONAL INSTITUTES OF 

4 HEALTH. 

5 Section 401(c)(2) of the Public Health Service Act 

6 (42 U.S.C. 281(c)(2)) is amended— 

7 (1) by redesignating subparagraph (B) as sub8 paragraph (C); and 

9 (2) by inserting after subparagraph (A) the fol10 lowing: 

11 ‘‘(B) PAIN CONSORTIUM.— 

12 ‘‘(i) ESTABLISHMENT.—The Director 

13 of NIH shall establish within the Division 

14 an office to be known as the Pain Consor15 tium (referred to in this subparagraph as 

16 the ‘Consortium’). 

17 ‘‘(ii) PURPOSES.—The purposes of the 

18 Consortium shall be to— 

19 ‘‘(I) establish and maintain a na20 tional agenda for basic and clinical re21 search on the causes and effective 

22 treatments for pain; 

23 ‘‘(II) coordinate and promote the 

24 pain research, research training, and 

25 other pain-related activities being carVerDate Aug 31 2005 19:52 Aug 02, 2008 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3387.IS S3387

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1 ried out in and across the institutes, 

2 centers, and programs of the National 

3 Institutes of Health; 

4 ‘‘(III) convene an annual con5 ference of prominent intramural and 

6 extramural experts in pain research, 

7 treatment, and management to assess 

8 and make recommendations with re9 spect to the pain research activities 

10 and programs of the National Insti11 tutes of Health; and 

12 ‘‘(IV) take such other actions as 

13 may be appropriate with respect to re14 search on the causes and effective 

15 treatments for pain. 

16 ‘‘(iii) REPRESENTATION OF INSTI17 TUTES.—The Consortium shall include the 

18 heads of the institutes, centers, and pro19 grams of the National Institutes of Health 

20 involved in pain research, as determined by 

21 the Director of NIH. 

22 ‘‘(iv) CHAIR.—The Consortium shall 

23 be chaired by the Director of the National 

24 Institute of Neurological Disorders and 


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1 Stroke, and shall have such co-chairs as 

2 the Director of NIH shall determine. 

3 ‘‘(v) ADVISORY COMMITTEE.— 

4 ‘‘(I) ESTABLISHMENT.—The Di5 rector of NIH shall establish an advi6 sory committee to the Consortium to 

7 be known as the National Pain Care 

8 Research Advisory Committee (in this 

9 section referred to as the ‘Advisory 

10 Committee’). 

11 ‘‘(II) ESTABLISHMENT.—The 

12 Advisory Committee shall be estab13 lished and maintained in accordance 

14 with the Federal Advisory Committee 

15 Act (5 U.S.C. Appendix). 

16 ‘‘(III) MEMBERSHIP.—The mem17 bers of the Advisory Committee shall 

18 consist of voting appointed members 

19 and nonvoting ex officio members as 

20 follows: 

21 ‘‘(aa) The voting appointed 

22 members of the Advisory Com23 mittee shall be appointed by the 

24 Director of NIH and shall in25 clude representatives of the broad 


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1 range of medical, health, and sci2 entific disciplines involved in pain 

3 research and pain care, including 

4 individuals with expertise and 

5 training in pain medicine, pain 

6 management, neuroscience, psy7 chology, social work, pharmacy 

8 and pharmacology, nursing, den9 tistry, and physical and occupa10 tional therapy, and patient rep11 resentatives. 

12 ‘‘(bb) The nonvoting ex offi13 cio members of the Advisory 

14 Committee shall be the Chair of 

15 the Consortium and such officials 

16 as the Director of NIH shall des17 ignate. 

18 ‘‘(IV) DUTIES.—The Advisory 

19 Committee shall advise, assist, consult 

20 with, and make recommendations to 

21 the Consortium regarding the matters 

22 set forth in clause (ii).’’. 

23 SEC. 5. PAIN CARE EDUCATION AND TRAINING. 

24 (a) PAIN CARE RESEARCH AND QUALITY.—Part A 

25 of title IX of the Public Health Service Act (42 U.S.C. 


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1 299 et seq.) is amended by adding at the end the fol2 lowing: 

3 ‘‘SEC. 904. PROGRAM FOR PAIN CARE RESEARCH AND 

4 QUALITY. 

5 ‘‘(a) IN GENERAL.—The Director shall carry out a 

6 program— 

7 ‘‘(1) to collect protocols and evidence-based 

8 practices regarding pain care at all stages of life; 

9 and 

10 ‘‘(2) to disseminate such information to Fed11 eral, State, and local regulatory and enforcement 

12 agencies, public and private health care programs, 

13 payors and providers, health professions schools, 

14 hospices, and the general public. 

15 ‘‘(b) CONSULTATION.—In carrying out this section, 

16 the Secretary shall consult with organizations representing 

17 patients in pain and other consumers, employers, physi18 cians including physicians specializing in pain care, other 

19 pain management professionals, medical device manufac20 turers, and pharmaceutical companies. 

21 ‘‘(c) DEFINITION.—For purposes of this section, the 

22 term ‘pain care’ means the assessment, diagnosis, treat23 ment, or management of acute or chronic pain regardless 

24 of causation or body location.’’. 


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1 (b) EDUCATION AND TRAINING IN PAIN AND PALLIA2 TIVE CARE.—Part D of title VII of the Public Health 

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

4 (1) by redesignating sections 754 through 758 

5 as sections 755 through 759, respectively; and 

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

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

8 PAIN CARE. 

9 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

10 with the Director of the Agency for Healthcare Research 

11 and Quality, may make awards of grants, cooperative 

12 agreements, and contracts to health professions schools, 

13 hospices, and other public and private entities for the de14 velopment and implementation of programs to provide 

15 education and training to health care professionals in pain 

16 care. 

17 ‘‘(b) PRIORITIES.—In making awards under sub18 section (a), the Secretary shall give priority to awards for 

19 the implementation of programs under such subsection. 

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

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

22 agrees that the program carried out with the award will 

23 include information and education on— 

24 ‘‘(1) recognized means for assessing, diag25 nosing, treating, and managing pain and related 


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1 signs and symptoms, including the medically appro2 priate use of controlled substances; 

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

4 policies on controlled substances, including the de5 gree to which misconceptions and concerns regarding 

6 such laws, regulations, rules, and policies, or the en7 forcement thereof, may create barriers to patient ac8 cess to appropriate and effective pain care; 

9 ‘‘(3) interdisciplinary approaches to the delivery 

10 of pain care, including delivery through specialized 

11 centers providing comprehensive pain care treatment 

12 expertise; 

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

14 and other barriers to care in underserved popu15 lations; and 

16 ‘‘(5) recent findings, developments, and im17 provements in the provision of pain care. 

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

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

20 professions schools, residency training programs, and 

21 other graduate programs in the health professions, entities 

22 that provide continuing education related to health profes23 sions, and such other programs or sites as the Secretary 

24 determines to be appropriate. 


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

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

3 the evaluation of programs implemented under subsection 

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

5 knowledge and practice of pain care. 

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

7 799(f) with respect to this section, the Secretary shall en8 sure that the membership of each peer review group in9 volved includes individuals with expertise and experience 

10 in pain care. 

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

12 term ‘pain care’ means the assessment, diagnosis, treat13 ment, or management of acute or chronic pain regardless 

14 of causation or body location.’’. 

15 (c) AUTHORIZATION OF APPROPRIATIONS.—Sub16 paragraph (C) of section 758(b)(1) of the Public Health 

17 Service Act (as redesignated by subsection (a)(1) of this 

18 section) is amended— 

19 (1) by striking ‘‘sections 753, 754, and 755’’ 

20 and inserting ‘‘section 753, 754, 755, and 756’’; and 

21 (2) by striking ‘‘not less than $22,631,000’’ 

22 and inserting ‘‘such sums as may be necessary’’. 

23 (d) TECHNICAL AMENDMENT.—Paragraph (2) of 

24 section 757(b) of the Public Health Service Act (as redes25 ignated by subsection (a)(1)) is amended by striking 


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1 ‘‘754(3)(A), and 755(b)’’ and inserting ‘‘755(3)(A), and 

2 756(b)’’. 

3 SEC. 6. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGE4 MENT. 

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

6 (42 U.S.C. 238 et seq.) is amended by adding at the end 

7 the following: 

8 ‘‘SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARE9 NESS CAMPAIGN ON PAIN MANAGEMENT. 

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

11 2009, the Secretary shall establish and implement a na12 tional pain care education outreach and awareness cam13 paign described in subsection (b). 

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

15 the public awareness campaign under this section to edu16 cate consumers, patients, their families, and other care17 givers with respect to— 

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

19 national public health problem; 

20 ‘‘(2) the adverse physical, psychological, emo21 tional, societal, and financial consequences that can 

22 result if pain is not appropriately assessed, diag23 nosed, treated, or managed; 

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

25 pain treatment and management options; 


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1 ‘‘(4) having pain promptly assessed, appro2 priately diagnosed, treated, and managed, and regu3 larly reassessed with treatment adjusted as needed; 

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

5 specialists and subspecialists, and of comprehensive 

6 interdisciplinary centers of treatment expertise; 

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

8 and private sectors of pain management-related in9 formation, services, and resources for consumers, 

10 employers, third-party payors, patients, their fami11 lies, and caregivers, including information on— 

12 ‘‘(A) appropriate assessment, diagnosis, 

13 treatment, and management options for all 

14 types of pain and pain-related symptoms; and 

15 ‘‘(B) conditions for which no treatment op16 tions are yet recognized; and 

17 ‘‘(7) other issues the Secretary deems appro18 priate. 

19 ‘‘(c) CONSULTATION.—In designing and imple20 menting the public awareness campaign required by this 

21 section, the Secretary shall consult with organizations rep22 resenting patients in pain and other consumers, employ23 ers, physicians including physicians specializing in pain 

24 care, and other pain management professionals. 

25 ‘‘(d) COORDINATION.— 


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1 ‘‘(1) LEAD OFFICIAL.—The Secretary shall des2 ignate one official in the Department of Health and 

3 Human Services to oversee the campaign established 

4 under this section. 

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

6 shall ensure the involvement in the public awareness 

7 campaign under this section of the Surgeon General 

8 of the Public Health Service, the Director of the 

9 Centers for Disease Control and Prevention, and 

10 such other representatives of offices and agencies of 

11 the Department of Health and Human Services as 

12 the Secretary determines appropriate. 

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

14 designing the public awareness campaign under this sec15 tion, the Secretary shall— 

16 ‘‘(1) take into account the special needs of geo17 graphic areas and racial, ethnic, gender, age, and 

18 other demographic groups that are currently under19 served; and 

20 ‘‘(2) provide resources that will reduce dispari21 ties in access to appropriate diagnosis, assessment, 

22 and treatment. 

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

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1 tions to assist with the development and implementation 

2 of the public awareness campaign under this section. 

3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—For 

4 purposes of carrying out this section, there are authorized 

5 to be appropriated such sums as may be necessary for 

6 each of fiscal years 2009, 2010, and 2011.’’. 

Æ 


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