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
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 http://thomas.loc.gov/ and enter HR 1863 in the
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]
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
- Issuing an annual report on the state of public and private funding for pain
- 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
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
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
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
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
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
(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
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.
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
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