This Program Announcement expires on July 31, 2004, unless reissued.

THE MANAGEMENT OF CHRONIC PAIN

Release Date:  July 2, 2001

PA NUMBER:  PA-01-115

National Institute of Nursing Research (NINR)
National Institute on Aging (NIA)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Center for Complementary and Alternative Medicine (NCCAM)
National Cancer Institute (NCI)
National Institute of Child Health and Human Development (NICHD)
National Institute of Dental and Craniofacial Research (NIDCR)
National Institute on Drug Abuse (NIDA)
National Institute of Neurological Disorders and Stroke (NINDS)

THIS PA USES THE "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS.  IT INCLUDES 
DETAILED MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE USED 
WHEN PREPARING APPLICATIONS IN RESPONSE TO THIS PA.

PURPOSE

The National Institute of Nursing Research and co-sponsoring Institutes and 
Centers encourage research proposals in the management of chronic pain across 
the lifespan.  Pain is a subjective experience influenced by gender, age, 
race/ethnicity and psychosocial factors.  The management of pain is influenced 
by patient, health care provider and system factors.  Research is needed to 
determine the most effective interventions to remove barriers to effective 
treatment, to determine the most effective pharmacological and non-
pharmacological therapies including complementary and alternative therapies, 
to identify assessment tools for patients unable to verbalize their pain, and 
to identify effective pain management strategies for individuals with 
disabilities and underserved populations.

HEALTHY PEOPLE 2010

The Public Health Service (PHS) is committed to achieving the health promotion 
and disease prevention objectives of "Healthy People 2010," a PHS led national 
activity for setting priority areas.  This Program Announcement (PA), The 
Management of Chronic Pain, is related to one or more of the priority areas.   
Potential applicants may obtain a copy of "Healthy People 2010" at 
http://www.health.gov/healthypeople/.

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, for-profit and non-
profit organizations, public and private, such as universities, colleges, 
hospitals, laboratories, units of State and local governments, and eligible 
agencies of the Federal government.  Racial/ethnic minority individuals, 
women, and persons with disabilities are encouraged to apply as principal 
investigators.

MECHANISM OF SUPPORT

This PA will use the National Institutes of Health (NIH) Research Project 
Grant (R01) award mechanism.  Responsibility for the planning, direction, and 
execution of the proposed project will be solely that of the applicant.  The 
total project period for an application submitted in response to this PA may 
not exceed 5 years.

Specific application instructions have been modified to reflect "MODULAR 
GRANT" and "JUST-IN-TIME" streamlining efforts being examined by the NIH. 
Complete and detailed instructions and information on Modular Grant 
applications can be found at 
http://grants.nih.gov/grants/funding/modular/modular.htm

RESEARCH OBJECTIVES

There are more than 50 million Americans who experience chronic pain and more 
than half of dying patients experience moderate to severe pain during the last 
days of their life.  Pain is a frequent cause for clinical visits with 
approximately 45% of the population seeking medical help for pain at some 
point in their lives.  Pain is found across the lifespan and it has been 
estimated that four out of every ten people with moderate or severe pain do 
not get adequate relief.

Pain is personal and subjective, is affected by mood and psychosocial factors, 
and demonstrates tremendous individual variation.   Depression commonly 
complicates pain and adds to the disability and impairment found in disorders 
with chronic pain.  Pain in combination with depression is a risk factor for 
suicide.  Pain interferes with quality of life, sleep and productivity, and 
pain increases utilization of health care resources.  However, many health 
care providers do not have the background to effectively treat pain.

Pain is frequently undertreated by healthcare providers.  For example, a 
survey of several hundred ambulatory AIDS patients found that fewer than 8% of 
patients reporting "severe" pain were prescribed a strong opioid such as 
morphine, despite published guidelines.  Adjuvant analgesic drugs (e.g., 
antidepressants) were also prescribed to only a small fraction of these 
patients.  Opioid analgesics are the accepted treatment for acute pain, cancer 
pain and pain at the end of life, and recently have been recommended for 
chronic, nonmalignant pain.  Patients can be treated with this therapy without 
developing tolerance, addiction or toxicity.  Nevertheless, health care 
providers continue to fear these adverse outcomes, and believe that opioid use 
may result in a downhill spiral of further disability, depression and pain, in 
spite of contrary evidence.  A further barrier to chronic opioid therapy is 
the lack of a good objective measure to determine whether a person requesting 
increased opioid dosage is abusing opioids or is receiving insufficient 
benefit from therapy.  This second scenario is so common in certain conditions 
(e.g., cancer, sickle cell disease) that the term “pseudo addiction,” has been 
used to describe the patient who is demonstrating drug-seeking behavior 
because his or her pain is undertreated.

In addition to health care provider barriers, there are patient and family 
barriers to effective pain relief.   Patients may underuse effective 
pharmacological treatments because of a stoic or fatalistic attitude, and/or a 
belief that complaining of pain makes one a “bad” patient.  Patients with 
cancer may believe that cancer pain cannot be alleviated; they may fear that 
pain indicates disease progression and/or they may fear that current usage 
will lead to future ineffectiveness.  Patients who are treated with opioids 
may have additional fears of dependence, addiction and tolerance, and fear of 
injections.   Thus, underusage may also be due to the stigma of using opioids.  
Research is needed to determine the relationship between patient-related 
barriers and pain management and to determine whether the patient barriers are 
a cause or result of inadequate treatment.  

Pain and pain management in infants is another area of research need.  
Premature infants often undergo painful medical and surgical procedures and 
may be in ongoing pain as a result.  Until recently it was believed that 
infants are insensitive to pain because of their immature nervous systems.  
Recent research demonstrates that infants do feel pain and a recent study on 
an animal model demonstrated that the pain experienced as a neonate resulted 
in greater sensitivity to pain as an adult.  Thus, painful procedures in 
infancy may lead to permanent changes in the pain threshold.  Effective pain 
interventions are needed for premature infants who are now surviving due to 
medical and technical advances.  

Individuals with certain demographic characteristics or medical conditions are 
likely to experience less effective pain management and report higher pain 
levels than others.  Older patients are often undertreated, especially the 
cognitively impaired.  Women may experience further undertreatment as they are 
over represented in certain conditions associated with pain such as 
fibromyalgia and temporomandibular joint disorders. In addition, individuals 
with less education or lower incomes, minority patients, patients with a 
history of injection drug use, and patients with AIDS are at risk for 
receiving suboptimal pain treatment.  The specific barriers to the 
undertreatment and underuseage of pain medication and non-pharmacological 
regimens need to be identified in these underserved populations.   

Similarly, chronic pain is frequently undertreated in those who are unable to 
verbalize their pain (e.g., premature infants, cognitively impaired 
individuals).  Assessment of chronic pain in nonverbal populations is 
difficult.  Sympathetic arousal is frequently found in acute pain, but is not 
commonly found in patients with chronic pain and therefore a patient may not 
look as if s/he is in pain.  The cues suggesting pain in nonverbal patients 
can be identified by those who are familiar with the patient and who can 
detect changes in behavior.  However, in any health care facility and 
particularly the long-term care facility, the staff turnover and different 
patient assignments are barriers to the assessment of pain in nonverbal 
patients.  Some cognitively impaired elders can report pain reliably in 
response to simple questions.  However, pain needs to be assessed in order to 
be treated.  The Department of Veterans Affairs and other health care 
institutions have institutionalized the assessment of pain as a fifth vital 
sign, similar to other vital signs like blood pressure, pulse, temperature and 
respiratory rate.  Other innovative systematic approaches to pain management 
are needed.  Educational training is not sufficient for instituting changes in 
pain management; further research on other institutional changes is needed to 
support pain management interventions in the practice setting. 

Non-pharmacological treatments have been found to be effective in managing 
chronic pain either alone or in combination with pharmacological therapy.  
These treatments include relaxation training, cognitive behavioral 
interventions, family support, biofeedback, and improving self-efficacy.  
Further research is needed to refine the most effective treatment strategies 
for specific conditions and to determine the most effective treatment 
strategies for underserved populations.  This research should include 
investigation of innovative complementary and alternative therapies for the 
effective treatment of chronic pain such as acupuncture, spinal manipulation 
and botanical products.  A recent report concluded that there is little 
research on the management of cancer pain.  The report recommended that 
further research is needed to determine the best combinations of 
pharmacological and non-pharmacological regimens in long-term cancer patients 
and in children with cancer pain.  In addition, further research is needed to 
determine the impact of ethnicity, race, gender, age, psychosocial context and 
culture on cancer pain.

Listed below are examples of studies that would be responsive to this program 
announcement.  However, these are only illustrative examples and applicants 
are encouraged to propose other topics consistent with the goals of this 
program.

o  Test interventions to remove the barriers to the effective treatment of 
pain by health care providers for all patients including those who are 
underserved;

o  Test interventions to remove the barriers to the usage of pharmacological 
therapy by patients;

o  Determine factors associated with the under-reporting of chronic pain 
and/or reporting that a treatment is effective when pain is not relieved; 

o  Develop and test measurement tools to assess chronic pain in patients who 
are unable to verbalize their pain (e.g., infants, patients with dementia);

o  Further explore the relationship between painful procedures and future pain 
sensitivity in premature infants;

o  Identify innovative biobehavioral interventions to control and alleviate 
chronic pain and the associated psychological distress in clinical and home 
settings;

o  Identify and test complementary and alternative therapies either alone or 
in combination with conventional therapies for the control and alleviation of 
chronic pain;

o  Test innovative methods for translating scientific advances in pain 
management into practice settings;

o  Identify which of the patient barriers are a cause or a result of 
psychological distress;

o  Develop a clinically effective monitoring system for opioid adherence and 
objective measures of tolerance and addiction;

o  Identify the patient and/or health care provider barriers associated with 
the underusage or undertreatment of pain specific for different cultural and 
ethnic/minority populations;

o  Test non-pharmacological interventions separately and in combination with 
pharmacological interventions to determine the most effective chronic pain 
management regimen;

o  Determine whether sensitivity or reactivity to pain is affected by dementia 
in the elderly;

o  Investigate the consequences of pharmacological pain management on 
cognition and functional abilities in the elderly, and particularly in persons 
with dementia;

o  Use psychophysical techniques to investigate pain threshold changes 
throughout the lifespan in patients experiencing chronic pain;

o  Study nociceptive pathways in older people with and without chronic pain 
using neuroimaging methods;

o  Study assessment and treatment of chronic pain in drug abusing populations 
both in and out of drug abuse treatment and study the effects of under-,  
over-, and appropriate treatment of chronic pain on the development and 
relapse of drug abuse;

o  Study interactions among drugs of abuse, medications used to treat drug 
abuse and its co-morbid conditions and medications used to treat drug abuse; 
and

o  Assess the medical/health consequences of abused/over-used pain 
medications.  

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of the NIH that women and members of minority groups and 
their sub-populations must be included in all NIH-supported biomedical and 
behavioral research projects involving human subjects, unless a clear and 
compelling rationale and justification are provided indicating that inclusion 
is inappropriate with respect to the health of the subjects or the purpose of 
the research.  This policy results from the NIH Revitalization Act of 1993 
(Section 492B of Public Law 103-43). 

All investigators proposing research involving human subjects should read the 
UPDATED "NIH Guidelines for Inclusion of Women and Minorities as Subjects in 
Clinical Research," published in the NIH Guide for Grants and Contracts on 
August 2, 2000 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-048.html); 
a complete copy of the updated Guidelines are available at  
http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm:  The 
revisions relate to NIH defined Phase III clinical trials and require: a) all 
applications or proposals and/or protocols to provide a description of plans 
to conduct analyses, as appropriate, to address differences by sex/gender 
and/or racial/ethnic groups, including subgroups if applicable; and b) all 
investigators to report accrual, and to conduct and report analyses, as 
appropriate, by sex/gender and/or racial/ethnic group differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of NIH that children (i.e., individuals under the age of 21) 
must be included in all human subjects research, conducted or supported by the 
NIH, unless there are scientific and ethical reasons not to include them.  
This policy applies to all initial (Type 1) applications submitted for receipt 
dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines on the Inclusion of Children as Participants in 
Research Involving Human Subjects" that was published in the NIH Guide for 
Grants and Contracts, March 6, 1998, and is available at the following URL 
address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html

Investigators also may obtain copies of these policies from the program staff 
listed under INQUIRIES.  Program staff may also provide additional relevant 
information concerning the policy.

REQUIRED EDUCATION IN THE PROTECTION OF HUMAN RESEARCH PARTICIPANTS

All investigators proposing research involving human subjects should read the 
policy that was published in the NIH Guide for Grants an Contracts, June 5, 
2000 (Revised August 25, 2000), available at:  
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. 

URLS IN NIH GRANT APPLICATIONS OR APPENDICES

All applications and proposals for NIH funding must be self-contained within 
specified page limitations.  Unless otherwise specified in an NIH 
solicitation, Internet addresses (URLs) should not be used to provide 
information necessary to the review because reviewers are under no obligation 
to view the Internet sites.  Reviewers are cautioned that their anonymity may 
be compromised when they directly access an Internet site.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT

The Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) cited 
publicly and officially by a Federal agency in support of an action that has 
the force and effect of law (i.e., a regulation) may be accessed through FOIA.  
It is important for applicants to understand the basic scope of this 
amendment.  NIH has provided guidance at:
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the application. 
In addition, applicants should think about how to structure informed consent 
statements and other human subjects procedures given the potential for wider 
use of data collected under this award.

APPLICATION PROCEDURES

Applications are to be submitted on the grant application form PHS 398 (rev. 
4/98) and will be accepted at the standard application deadlines as indicated 
in the application kit.  Application kits are available at most institutional 
offices of sponsored research and may be obtained from the Division of 
Extramural Outreach and Information Resources, National Institutes of Health, 
6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/435-
0714, email: GrantsInfo@nih.gov.

Applicants planning to submit an investigator-initiated new (type 1), 
competing continuation (type 2), competing supplement, or any amended/revised 
version of the preceding grant application types requesting $500,000 or more 
in direct costs for any year are advised that he or she must contact the 
Institute or Center (IC) program staff before submitting the application, i.e, 
as plans for the study are being developed.  Furthermore, the application must 
obtain agreement from the IC staff that the IC will accept the application for 
consideration for award.  Finally, the applicant must identify, in a cover 
letter sent with the application, the staff member and Institute or Center who 
agreed to accept assignment of the application.  

This policy requires an applicant to obtain agreement for acceptance of both 
any such application and any such subsequent amendment.  Refer to the NIH 
Guide for Grants and Contracts, March 20, 1998 at 
http://grants.nih.gov/grants/guide/notice-files/not98-030.html

The modular grant concept establishes specific modules in which direct costs 
may be requested as well as a maximum level for requested budgets. Only 
limited budgetary information is required under this approach.  The 
just-in-time concept allows applicants to submit certain information only when 
there is a possibility for an award. It is anticipated that these changes will 
reduce the administrative burden for the applicants, reviewers and Institute 
staff.  The research grant application form PHS 398 (rev. 4/98) is to be used 
in applying for these grants, with the modifications noted below.

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS

BUDGET INSTRUCTIONS

Modular Grant applications will request direct costs in $25,000 modules, up to 
a total direct cost request of $250,000 per year. (Applications that request 
more than $250,000 direct costs in any year must follow the traditional PHS 
398 application instructions.)  The total direct costs must be requested in 
accordance with the program guidelines and the modifications made to the 
standard PHS 398 application instructions described below:

PHS 398

o FACE PAGE: Items 7a and 7b should be completed, indicating Direct Costs (in 
$25,000 increments up to a maximum of $250,000) and Total Costs [Modular Total 
Direct plus Facilities and Administrative (F&A) costs] for the initial budget 
period Items 8a and 8b should be completed indicating the Direct and Total 
Costs for the entire proposed period of support.

o DETAILED BUDGET FOR THE INITIAL BUDGET PERIOD - Do not complete Form Page 4 
of the PHS 398. It is not required and will not be accepted with the 
application.

o BUDGET FOR THE ENTIRE PROPOSED PERIOD OF SUPPORT - Do not complete the 
categorical budget table on Form Page 5 of the PHS 398. It is not required and 
will not be accepted with the application.

o NARRATIVE BUDGET JUSTIFICATION - Prepare a Modular Grant Budget Narrative 
page. (See http://grants.nih.gov/grants/funding/modular/modular.htm for sample 
pages.) At the top of the page, enter the total direct costs requested for 
each year.  This is not a Form page.

o Under Personnel, list all project personnel, including their names, percent 
of effort, and roles on the project. No individual salary information should 
be provided. However, the applicant should use the NIH appropriation language 
salary cap and the NIH policy for graduate student compensation in developing 
the budget request.

For Consortium/Contractual costs, provide an estimate of total costs (direct 
plus facilities and administrative) for each year, each rounded to the nearest 
$1,000. List the individuals/organizations with whom consortium or contractual 
arrangements have been made, the percent effort of all personnel, and the role 
on the project. Indicate whether the collaborating institution is foreign or 
domestic. The total cost for a consortium/contractual arrangement is included 
in the overall requested modular direct cost amount.  Include the Letter of 
Intent to establish a consortium.

Provide an additional narrative budget justification for any variation in the 
number of modules requested.

o BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by  
reviewers in the assessment of each individual's qualifications for a specific 
role in the proposed project, as well as to evaluate the overall 
qualifications of the research team. A biographical sketch is required for all 
key personnel, following the instructions below. No more than three pages may 
be used for each person. A sample biographical sketch may be viewed at:  
http://grants.nih.gov/grants/funding/modular/modular.htm

- Complete the educational block at the top of the form page;
- List position(s) and any honors;
- Provide information, including overall goals and responsibilities, on 
research projects ongoing or completed during the last three years.
- List selected peer-reviewed publications, with full citations;

o CHECKLIST - This page should be completed and submitted with the 
application. If the F&A rate agreement has been established, indicate the type 
of agreement and the date. All appropriate exclusions must be applied in the 
calculation of the F&A costs for the initial budget period and all future 
budget years.

o The applicant should provide the name and phone number of the individual to 
contact concerning fiscal and administrative issues if additional information 
is necessary following the initial review. 

The title and number of the program announcement must be typed on line 2 of 
the face page of the application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the 
Checklist, and five signed photocopies in one package to:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)

REVIEW CONSIDERATIONS

Applications will be assigned on the basis of established PHS referral 
guidelines.  Applications will be evaluated for scientific and technical merit 
by an appropriate scientific review group convened in accordance with the 
standard NIH peer review procedures.  As part of the initial merit review, all 
applications will receive a written critique and undergo a process in which 
only those applications deemed to have the highest scientific merit, generally 
the top half of applications under review, will be discussed, assigned a 
priority score, and receive a second level review by the appropriate national 
advisory council or board.

Review Criteria

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments reviewers will be asked to discuss the following aspects 
of the application in order to judge the likelihood that the proposed research 
will have a substantial impact on the pursuit of these goals.  Each of these 
criteria will be addressed and considered in assigning the overall score, 
weighting them as appropriate for each application.  Note that the application 
does not need to be strong in all categories to be judged likely to have major 
scientific impact and thus deserve a high priority score.  For example, an 
investigator may propose to carry out important work that by its nature is not 
innovative but is essential to move a field forward.

(1) Significance:  Does this study address an important problem?  If the aims 
of the application are achieved, how will scientific knowledge be advanced?  
What will be the effect of these studies on the concepts or methods that drive 
this field?

(2) Approach:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of the 
project?  Does the applicant acknowledge potential problem areas and consider 
alternative tactics?

(3) Innovation:  Does the project employ novel concepts, approaches or method? 
Are the aims original and innovative?  Does the project challenge existing 
paradigms or develop new methodologies or technologies?

(4) Investigator:  Is the investigator appropriately trained and well suited 
to carry out this work?  Is the work proposed appropriate to the experience 
level of the principal investigator and other researchers (if any)?

(5) Environment:  Does the scientific environment in which the work will be 
done contribute to the probability of success?  Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements?  Is there evidence of institutional 
support?

In addition to the above criteria, in accordance with NIH policy, all 
applications will also be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and their 
subgroups, and children as appropriate for the scientific goals of the 
research.  Plans for the recruitment and retention of subjects will also be 
evaluated.

o  The reasonableness of the proposed budget and duration in relation to the 
proposed research

o  The adequacy of the proposed protection for humans, animals or the 
environment, to the extent they may be adversely affected by the project  
proposed in the application.

AWARD CRITERIA

Applications will compete for available funds with all other recommended 
applications. The following will be considered in making funding decisions:  
Quality of the proposed project as determined by peer review, availability of 
funds, and program priority.

INQUIRIES

Inquiries are encouraged.  The opportunity to clarify any issues or questions 
from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Dr. Karin Helmers
Office of Extramural Programs
National Institute of Nursing Research
Building 45, Room Number 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-2177
FAX:  (301) 480-8260
Email: Karin_helmers@nih.gov

Dr. Elisabeth Koss
Neuroscience and Neuropsychology of Aging Program
National Institute on Aging
7201 Wisconsin Avenue, Suite 3C307 MSC 9205
Bethesda, MD  20892-9205
Telephone:  (301) 496-9350
FAX:  (301) 496-1494
Email:  kosse@nia.nih.gov

Dr. Deborah N. Ader
Director, Behavioral and Prevention Research Program
National Institute of Arthritis and Musculoskeletal and Skin Diseases
45 Center Drive, Building 45, Room 5A19H
Bethesda, MD  20892-6500
Telephone: (301) 594-5032
FAX: (301) 480-4543
Email: adere@mail.nih.gov

Dr. Nancy Pearson
Program Officer
Neuroscience, Mental Health, NRSA Training Programs
National Center for Complementary and Alternative Medicine
6707 Democracy Boulevard, Room 106, MSC 5475
Bethesda, MD  20892-5475
Telephone: (301) 594-0519
FAX: (301) 480-3621
Email: pearsonn@mail.nih.gov

Dr. Christine Goertz
Program Officer
Musculoskeletal Disease, Skin Disease, Addiction, Health Services Research
National Center for Complementary and Alternative Medicine
6707 Democracy, Boulevard, Room 106, MSC 5475
Bethesda, MD  20892-5475
Telephone: (301) 402-1030
FAX: (301) 480-3621
Email: Goertzc@mail.nih.gov

Dr. Claudette Varricchio
Program Director
Division of Cancer Prevention
National Cancer Institute
6130 Executive Blvd.  EPN 300
Bethesda, MD, 20892
Telephone: (301) 496-8541
FAX: (301) 496-8667
Email: varriccc@mail.nih.gov

Dr. Beth M. Ansel
National Center for Medical Rehabilitation Research
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 2A03, MSC 7510
Bethesda, MD 20892-7510
Telepohone: (301) 402-2242
FAX:  (301) 402-0832
E-mail:  Beth_Ansel@nih.gov

Dr. Kenneth A. Gruber
Chief, Chronic Diseases Branch
Division of Extramural Research
National Institute of Dental and Craniofacial Research
Natcher Building, Room 4AN-18C
Bethesda, MD  20892-6402
Telephone:  (301) 594-4836
FAX:  (301) 480-8318
Email:  Kenneth.Gruber@nih.gov

Dr. Jag H. Khalsa
Health Scientist Administrator
Center on AIDS & Other Medical Consequences of Drug Abuse (CAMCODA)
National Institute on Drug Abuse
6001 Executive Boulevard, Rm 5198, MSC 9593
Bethesda, MD 20892-9593
Telephone: (301) 443-1801 (443-2159 direct)
FAX: (301) 443-4100
e-mail: jk98p@nih.gov

Dr. Cheryl Kitt
Program Director
Systems and Cognitive Neuroscience
National Institute of Neurological Disorders and Stroke
6001 Executive Blvd., Rm. 2116
Rockville, MD  20892
Telephone: 301-496-9964
FAX: 301-402-2060
Email: kittc@ninds.nih.gov

Direct inquiries regarding fiscal matters to:

Ms. Sally York
Office of Grants and Contract Management
National Institute of Nursing Research
Building 45, Room Number 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-2154
FAX:  (301) 480-8260
Email: Sally_york@nih.gov

Ms. Linda Whipp
Grants Management Officer
Grants and Contracts Management Office
National Institute on Aging
7201 Wisconsin Avenue, Suite 2N212, MSC 9205
Bethesda, MD  20892-9205
Telephone:  (301) 496-1472
FAX:  (301) 402-3672
Email:  lw17m@nih.gov

Melinda B. Nelson
Chief Grants Management Officer
National Institute of Arthritis and Musculoskeletal and Skin Diseases
45 Center Drive, Room 5AS49
Bethesda, Maryland  20892
Telephone: (301) 435-5278
FAX: (301) 480-4543
Email: nelsonm@mail.nih.gov

Ms. Victoria Carper
National Center for Complementary and Alternative Medicine (NCCAM)
National Institutes of Health
6707 Democracy Blvd. Suite 106
Bethesda, MD 20892-5475
(FedEx, UPS or other courier use zip code 20817)
Telephone: (301) 594-9102
FAX: (301) 480-3621
Email: carperv@mail.nih.gov

Ms. Eileen Natoli
Grants Administration Branch
National Cancer Institute
6120 Executive Boulevard, Room 243, MSC 7150
Rockville, MD  20892-7150
Telephone: (301) 496-8791
FAX: (301) 402-0275
Email: natolie@gab.nci.nih.gov

Mr. Christopher Myers
Grants Management Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17H, MSC 7510
Bethesda, MD m20892-7510
Telephone:  (301)435-6996
FAX:  (301) 402-0915
E-mail: cm143g@nih.gov

Mr. Martin Rubinstein
Office of Grants Management
National Institute of Dental and Craniofacial Research
Natcher Building, Room 4AN-44A
Bethesda, MD  20892-6402
Telephone:  (301) 594-4800
FAX:  (301) 480-8301
Email:  Martin.Rubinstein@nih.gov

Mr. Gary Fleming
Grants Management Branch
National Institute on Drug Abuse
6001 Executive Boulevard, Room 3131, MSC 9541
Bethesda, MD  20892-9541
Telephone:  (301) 443-6710
FAX :  (301) 594-6847
E-mail: gf6s@nih.gov

Ms. Sheila Simmons
Grants Management Branch
National Institute of Neurological Disorders and Stroke
6001 Executive Boulevard
Rockville, MD  20892
Telephone:  (301) 496-8084
FAX :  (301) 402-0219
E-mail: ss443y@nih.gov

AUTHORITY AND REGULATIONS 

This program is described in the Catalog of Federal Domestic Assistance No. 
93.361 (NINR), 93.866 (NIA), 93.846 (NIAMS), 93.213 (NCCAM), 93.393 (NCI), 
93.929 (NICHD), 93.158 (NIDCR), 93.279 (NIDA), and 93.853 (NINDS). Awards are 
made under authorization of sections 301 and 405 of the Public Health Service 
Act as amended (42 USC 241 and 284) and administered under NIH grants policies 
and Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92.  This program is 
not subject to the intergovernmental review requirements of Executive Order 
12372 or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products.  In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking 
in certain facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.

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	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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