[Congressional Record (Bound Edition), Volume 154 (2008), Part 15]
[House]
[Pages 20288-20291]
[From the U.S. Government Publishing Office, www.gpo.gov]




                 NATIONAL PAIN CARE POLICY ACT OF 2008

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 2994) to amend the Public Health Service Act with respect to 
pain care, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 2994

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

     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:

[[Page 20289]]



     ``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 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.
       ``(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:

     ``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;
       ``(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

[[Page 20290]]

     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.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Burgess) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and to 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 2994, the National Pain Care 
Policy Act of 2007, a bill to amend the Public Health Service Act with 
respect to pain care. All of us have probably experienced pain 
resulting from an illness or disease in our lives. Some people are 
fortunate enough to be able to access drugs and other treatments to 
relieve pain and suffering.
  However, millions are not able to obtain that relief and suffer from 
acute pain. The National Center for Health Statistics estimates that 
one in every four Americans has suffered from pain that lasts longer 
than 24 hours. Pain can impact every aspect of our daily lives, from an 
inability to work, to being unable to spend time with family and 
friends.
  This bill would do much to help us better manage pain. H.R. 2994 
would encourage the Secretary of Health and Human Services to enter 
into an agreement with the Institute of Medicine to convene a 
conference on pain, encourage the Director of the National Institutes 
of Health to expand a research program on the causes of and potential 
treatment for pain, establish an interagency pain research coordinating 
committee within HHS, allow the HHS Secretary to award grants to public 
and private entities for the development of programs to provide 
education and training to health care professionals in pain care, and 
require the HHS Secretary to establish and implement a national pain 
care education outreach and awareness campaign.
  Pain is the leading reason Americans come into contact with the 
health care system, and it's also a huge contributor to the growing 
costs of health care. We must do a better job of helping to alleviate 
that suffering, and I believe this bill would go a long way towards 
achieving that end.
  I want to thank my colleagues on the Energy and Commerce Committee, 
particularly Congresswoman Capps and Congressman Rogers, for their 
leadership on this issue. I urge my colleagues to join me in voting for 
adoption of this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  I rise in support of H.R. 2994, the National Pain Care Policy Act of 
2008. Certainly, I also want to join the chairman of the subcommittee 
in commending Congresswoman Lois Capps and Congressman Mike Rogers for 
their work on this bill.
  Chronic pain is disabling, and it's debilitating. It would certainly 
be frustrating for both the patients and caregivers alike. Fortunately, 
most painful conditions can be relieved with proper treatment and 
adequate pain management. This bill will create an interagency 
coordinating committee to coordinate all the efforts within the Health 
and Human Services and other Federal agencies related to pain research.
  This effort, along with other efforts of the National Institutes of 
Health, via the pain consortium, will go a long way towards increasing 
research and awareness of chronic pain. I do urge Members to support 
this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the sponsor of the 
bill, the gentlewoman from California (Mrs. Capps).
  Mrs. CAPPS. Mr. Speaker, I rise in strong support of H.R. 2994, the 
National Pain Care Policy Act.
  I want to thank the chairman of our subcommittee, Mr. Pallone, for 
yielding me the time and also for his leadership in making sure this 
bill has gotten to this point.
  I thank the chairman of the full committee, Mr. Dingell, and our 
staff who are here and have been working diligently on both sides of 
the aisle to get this bill to where it is today. I thank our colleague 
from Michigan, Mike Rogers, for his work in paving the way for the 
passage of this bill today.
  The National Pain Care Policy Act would take important steps to 
improve the coordination of research and treatment of pain. More than 
75 million Americans suffer from pain, both chronic and acute, making 
pain the most common reason Americans access or try to access the 
health care system.
  Yet they often face significant barriers in receiving the proper 
diagnosis and treatment. Pain is often, too often, only researched and 
considered as a symptom of another disease, and best practices haven't 
always been shared across disciplines.
  H.R. 2994 would amplify research at the National Institutes of Health 
and also improve education and outreach efforts for health 
professionals and the general public alike. I am proud of the 
significant support we have received in the community from various 
advocacy groups, health professionals and providers.
  I urge all of our colleagues to vote ``yes'' on H.R. 2994.

                                              American Association


                                        of Nurse Anesthetists,

                               Washington, DC, September 22, 2008.
     Hon. Lois Capps,
     House of Representatives,
     Washington, DC.
       Dear Congresswoman Capps: On behalf of the more than 39,000 
     members of the American Association of Nurse Anesthetists 
     (AANA), I am pleased to express the Association's support for 
     HR 2994, the National Pain Care Policy Act of 2007.
       The AANA is the professional association for Certified 
     Registered Nurse Anesthetists (CRNAs) and student nurse 
     anesthetists, representing over 90 percent of the nurse 
     anesthetists in the United States. CRNAs are advanced 
     practice nurses who administer about 30 million anesthetics 
     to patients each year in the U.S., provide assessment and 
     evaluation for acute and chronic pain and deliver pain 
     management services, and are the sole anesthesia providers in 
     most rural hospitals, affording these medical facilities 
     obstetrical, surgical, and trauma stabilization, and pain 
     management capabilities.
       AANA is pleased to support HR 2994, which seeks to 
     eliminate barriers to pain care and improve pain care 
     research, education, and clinical practice. Recognizing that 
     pain is both a significant public health challenge and a 
     burden to millions of Americans' quality of life, we believe 
     that adoption of the National Pain Care Policy Act would help 
     focus our nation's healthcare research in a

[[Page 20291]]

     new and important way on the cause, prevention, treatment and 
     management of pain. As recognized experts in the field of 
     anesthesia and pain management, America's CRNAs have made 
     substantial contributions to clinical practice in pain care, 
     and help provide millions of patients relief from pain. As HR 
     2994 would help focus national resources on research and 
     translate research findings into improved clinical practice, 
     we ask that upon the measure's enactment that representatives 
     of the profession of nurse anesthesia be represented on 
     government panels and councils that the legislation 
     authorizes, such as the National Institutes of Health (NIH) 
     National Pain Care Research Advisory Committee, the 
     development of the Institute of Medicine Conference on Pain, 
     the development of the Secretary of Health and Human 
     Services' Public Awareness Campaign on Pain Management, and 
     any others intended to guide and lead this critical 
     healthcare policy agenda. In addition, we ask that grants 
     that the legislation would authorize for expanding education 
     and training to health care professionals in pain care also 
     be made available to accredited nurse anesthesia educational 
     programs.
       The AANA applauds the work of the Committee on Energy and 
     Commerce for its bipartisan effort in advancing the National 
     Pain Care Policy Act and will continue working toward its 
     enactment. If we can be of further assistance, please contact 
     Frank Purcell, AANA Senior Director Federal Government 
     Affairs.
           Sincerely,
                                                 Jackie S. Rowles,
                                                        President.

  Mr. BURGESS. Mr. Speaker, I would just simply add that many 
providers, many physicians across the country, will welcome that 
establishment of parameters and best practices. Oftentimes we feel 
caught between the situation where do we provide adequate pain relief 
to our patients and perhaps risk scrutiny from the department of drug 
enforcement, or do we risk the scrutiny of the patient and their family 
because of inadequate efforts at pain management.
  Oftentimes it can be a fine line and quite a balancing act. I think 
we will go a long way towards alleviating the suffering of those who 
are sufferers of chronic and debilitating pain, but also provide 
additional resources to the caregivers when faced with these difficult 
situations.
  Mr. Speaker, I have no further requests for time on my side, and I 
will yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I have no further requests for time. I 
would urge adoption of this bill dealing with pain care policy and 
yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 2994, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BURGESS. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.
  The point of no quorum is considered withdrawn.

                          ____________________