National Pain Care Policy Act of 2003
American Pain Foundation

201 N. Charles Street, Suite 710
Baltimore, MD 21201
Phone (410) 783-7292
Fax (410) 385-1832

Date: 1 May 2003

To: Friends of APF
From: Eddie Rivas, Director of Government Affairs

Re: HR 1863, National Pain Care Policy Act of 2003

On Tuesday, April 29, Congressman Mike Rogers (R-MI) introduced H.R. 1863, the National Pain Care Policy Act of 2003 in the House of Representatives. The bill is an exceptional step toward gaining federal recognition of the importance of pain as a critical and unanswered health care problem in our nation. However, we still have plenty to do before this bill becomes law, not the least of which is getting similar legislation introduced in the Senate.

HR 1863 is the first comprehensive legislation with a multidisciplinary approach. It was introduced in response to the Congressionally declared Decade of Pain Research, which started in January 2001. The fact that this bill addresses research, professional education and training, public awareness, treatment in specific federal heath care plans, and seeks White House support for pain care lays a strong foundation for confronting this crisis that costs our economy between $80 and $100 billion each year.

Over the past eighteen months, APF has been working collaboratively with the Pain Care Coalition (PCC) to develop a comprehensive pain care bill. Representative Rogers says the bill incorporates many of our positions, although is not as comprehensive as our combined legislative ideas. This bill also reflects many of the suggestions we have collected over time from conversations with numerous groups representing health care providers, consumers, disease-specific organizations and others. APF wishes to thank the PCC for their early efforts in drafting this legislation.

It is our understanding that Representative Rogers is now in the process of gathering support from his colleagues for the bill and is looking for cosponsors of the legislation. Please review the following summary of the provisions of this legislation. To view the latest available version of H.R. 1863, go to and enter HR 1863 in the search field.

For those of you inclined to take action at this time, included is a sample letter that could be used to write your Members of Congress to request her/his support as a cosponsor for H.R. 1863. Also included are talking points for conversations about pain in their offices.

If you have any questions, please contact me at [email protected]
or by calling 410-783-7292, extension 300.

Thank you.

Eddie Rivas


Summary of the "National Pain Care Policy Act of 2003"

Section 1: Short Title

Provides that the title of the bill shall be the "National Pain Care Policy Act of 2003."

Section 2: White House Conference on Pain Care

Authorizes a White House Conference on Pain Care.

The purposes of the conference would be to:

  • Increase the awareness of pain as a significant public health problem
  • Assess the adequacy of diagnosis and treatment of pain care
  • Identify barriers to appropriate pain care
  • Establish an agenda for the Decade of Pain Control and Research, stimulating public and private sector efforts to improve the state of pain care research, education, and clinical care by the year 2010

Section 3: National Center for Pain and Palliative Care Research

Establishes a National Center for Pain and Palliative Care Research at the National Institutes of Health. Primary functions of the Center would include:

  • Supporting clinical and basic science research into the causes and effective treatments for pain
  • Initiating a comprehensive program of collaborative interdisciplinary research among schools, colleges, and universities
  • Establishing a national agenda for conducting and supporting pain research, including acute pain; cancer and HIV-related pain; chronic and intractable pain; and other painful conditions
  • Coordinating all pain research and related activities being carried out at NIH
  • Issuing an annual report on the state of public and private funding for pain care research
  • Establishes a National Pain and Palliative Care Research Center Advisory Board at NIH.
  • Authorizes six regional pain research centers.
    Requires a national consensus conference of prominent researchers and clinicians in the field of pain care research and treatment.

Section 4: Pain Care Education and Training

Requires the Agency for Healthcare Research and Quality (AHRQ) to:

  • Collect and disseminate protocols and evidence-based practices regarding pain and palliative care clinicians and the general public.
  • Fund education and training programs for health care professionals in pain and palliative care.

Section 5: Public Awareness Campaign on Pain Management

Requires the Secretary of DHHS to develop and implement a national outreach and awareness campaign to educate consumers, patients, families and other caregivers on:

  • The significance of pain as a national public health problem
  • The risks to patients if pain is not properly treated
  • The availability of treatment options for different types of pain
  • The patients right to have pain assessed and treated across health care settings
  • Where patients and other consumers can go for help in dealing with pain

Section 6: Pain Care Initiative in Military Health Facilities

Requires the Secretary of Defense to develop and implement a pain care initiative in all military health care facilities to ensure that all personnel receiving treatment in military health care facilities are assessed for pain at the time of admission or initial treatment, and that they receive appropriate pain care.

Section 7: Pain Care Standards in Medicare+Choice Plans

Requires managed health care plans that offer Medicare+Choice plans to older persons to offer appropriate care for the treatment of patients in pain, including specialty and tertiary care for patients with intractable pain.

Section 8: Pain Care Standards in TRICARE Plans

Requires similar protections for military personnel and dependents enrolled in TRICARE plans.

Section 9: Annual Report on Medicare Expenditures for Pain Care Services

Requires CMS to submit to Congress an annual report on Medicare expenditures for pain and palliative care.

Section 10: Pain Care Initiative in Veterans Health Care Facilities

Requires the Secretary of the VA to develop and implement a pain care initiative in all VA health care facilities to ensure that all veterans receiving treatment in those facilities are assessed for pain at the time of admission or initial treatment, and that they receive appropriate pain care.

(A sample letter you can use)


The Honorable (full name)
United States House of Representatives
Washington DC 20515

Dear Representative (last name):
I am writing to ask that you lend your support to H. R. 1863, the National Pain Care Policy Act of 2003, by becoming a cosponsor of this important legislation.

Pain care is a significant public health issue that is not formally addressed by our health care system. While Medicare and Medicaid treat pain related to an acute episode or to hospitalization, chronic pain is not covered by public or private health care insurance in general. A 1999 study entitled Chronic Pain in America found that only 1 in 4 of those with pain received adequate treatment. Yet untreated or under-treated pain places high costs our national economy. Pain affects over 75 million individuals every year, 50 million of those suffering from chronic pain. The recent (2002) American Productivity Audit estimates that pain costs our economy over $78 billion is lost productive work time, accounting for approximately 80 percent of lost time within the work environment.

(Add here a story about someone you know who has experienced pain that has not been appropriately diagnosed and treated, or cite an example of how far someone in your congressional district would have to travel to receive adequate pain care.)

The Pain Care Policy Act of 2003 provides important federal recognition of pain as a priority public health problem in the United States, and authorizes additional federal resources for pain care research, professional education, public awareness and professional training. In addition, it has provisions to improve access to appropriate diagnosis and treatment for pain in federally financed health care facilities and federally financed managed care programs.

Please consider becoming a cosponsor of H.R. 1863. If you or your staff needs additional information, please contact Representative Rogers health staff at (202) 225-4872.

Thank you for your consideration of this request.

Your name____________________

Talking Points on Pain

Magnitude of the Pain Problem

Over 75 million Americans suffer serious pain annually: 50 million of those endure serious chronic pain annually (pain lasting 6 months or more), and another 25 million experience acute pain (from injuries, accidents, surgeries, etc.). [National Pain Survey, conducted for Ortho-McNeil Pharmaceutical, 1999]

Headache, lower back pain, arthritis and other joint pain, and peripheral neuropathy are the most common forms of chronic pain. ["Pain in America," study sponsored by Mayday Fund, 1998]

Over 26 million adults experience frequent back pain and 2/3 of Americans will have back pain during their lifetime. [Dionne, C.E., "Low back pain," Epidemiology of Pain, (Seattle:IASP) 1999.]

1 in 6 Americans suffers from arthritis. [Lawrence, R.C., et al, "Estimates of the Prevalence of Arthritis and Selected Musculos-Skeletal Disorders in the United States," Arthritis and Rheumatism, 1998.]

Close to 4 million Americans -- mostly women -- suffer from fibromyalgia, a complex condition involving widespread pain and other symptoms.

The Gross Undertreatment of Pain in America

A 1999 study, Chronic Pain in America, found that only 1 in 4 of those with pain received adequate treatment. ["Chronic Pain in America," survey conducted for American Pain Society, American Academy of Pain Medicine and Janssen Pharmaceutica, 1999.]

An estimated 70% of those with cancer experience significant pain during their illness, yet in an early study of cancer pain fewer than half received adequate treatment for their pain. [Grossman, S., et al, "Correlation of patient and caregiver ratings of cancer pain," Journal of Pain and Symptom Management, 1991; and Von Roenn, et al, "Physician Attitude and Practice in Cancer Pain Management," Annals of Internal Medicine, 15 July 1993 (119:2).

A recent study published in the Journal of the American Medical Association (JAMA) of nursing home patients with cancer found that 24% of patients with significant pain received nothing stronger than aspirin.

Another study recently published in JAMA found that 41% of nursing home patients who were admitted with moderate to severe pain still had approximately the same level of pain 6 months later.

The Cost of Pain to Society

The National Institute of Health estimates that pain costs us over $100 billion/year in medical expenses, lost wages and other costs. [National Institute of Health, The NIH guide: New directions in pain research I, Washington, DC:GPO, 1998.]

A study found that 50 million workdays were lost to pain in 1995. ["Pain and absenteeism in the workplace," study conducted for Ortho-McNeil Pharmaceutical, 1997.] The same study revealed that untreated pain results in lower productivity, greater employee absenteeism, and higher insurance premiums.

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