Neuropathic Pain: Treatments and Prescribing Practices - A Global Survey 2009
BioPharm Reports (VennBio Ltd.), July 2009, Pages: 188
With estimated prevalence levels of 3-10%, the treatment of Neuropathic Pain (NP) remains an area of significant unmet need. NP is highly individual in its presentation, level, underlying pathology and response to therapy. For some patients, available therapies give satisfactory pain control. For many others, treatments are poor or do not work at all. Therapeutic options include more than ten drug classes, which are commonly prescribed in combinations tailored to individual patient needs.
Interventional treatments, such as peripheral nerve block and transcutaneous electrical nerve stimulation, are also used as physicians seek other approaches to treating NP. This background, the individual nature of NP and the drug (or drug combination) options used to treat patients, has created a complex therapeutic picture.
In a therapeutic field where treatments are often unsatisfactory, physicians seek to extent their understanding of NP in an effort to define needs and limitations. Knowledge in these areas is also important to drug developers, who seek a better understanding of patient needs and outcomes, as part of their own efforts to develop more effective therapies. To meet interest in these areas, Biopharm Reports has conducted an in-depth global survey on current treatments and drug prescribing practices, relating to NP. This survey involved the participation of more than 330 physicians and clinical centres in 56 countries.
Overview:
Comprehensive details of current treatments for NP, provided by more than 330 clinics in 56 countries
In-depth information relevant to markets and opportunities in the NP field.
98% of participants are practicing physicians, working in specialised areas of pain treatment. Of these, 78% described themselves as specialists in pain treatment.
Leading participant countries were USA, Canada, UK, Australia, Denmark, France, Brazil, Germany, Netherlands and Belgium.
74% of the clinical centres participating in this study were hospital pain departments, specialised pain practices or private pain clinics. Detailed information on the use of specific drug classes including tricyclic antidepressants, SSRIs, SNRIs, anticonvulsants, sodium channel blockers, opioids, NSAIDS, cannabinoids and Capsaicin.
- Physicians have provided detailed feedback on the underlying pathologies associated with NP, seen in their patients.
- Comprehensive information on the most frequently prescribed drugs from nine drugs classes, including drug combinations, for the treatment of NP.
- Biopharm Reports believes this provides the most comprehensive and up-to-date review and analysis in this area, currently available.
- A detailed analysis of interventional methods used for the treatment of NP (e.g. peripheral nerve block, TENS).
- An assessment of average levels of pain relief achieved in the treatment of NP, in relation to 12 underlying conditions.
- Informative views of participating physicians on current limitations, challenges and issues relating to the treatment of NP.
Information surveyed:
- Participant details: Participant organisation, type of clinical practice or department; type of pain physician
- NP treatment strategies: Relative proportion of drug and interventional treatments
- Diagnoses and underlying pathologies: For example, Diabetes, post cancer radiotherapy or chemotherapy, post general surgery, Trigeminal Neuralgia, viral Infections, injury/trauma, post back surgery, primary back problems, complex regional pain syndrome (CRPS), Multiple Sclerosis, central pain, Arthritis, Others NP pathologies
- Single or combined drug treatments
- Drug classes used: For example, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenalin reuptake inhibitors (SNRIs), anticonvulsants, sodium channel blockers, opioids, non-steroidal anti-inflammatory drugs, cannabinoids, Capsaicin and others
- Tricyclic Antidepressants: First, second and third most frequently used
- Non-steroidal anti-inflammatory drugs: First, second and third most frequently used
- Cannabinoids
- Capsaicin
- Drug combinations: First, second and third most frequently used drug combinations (i.e. combinations of two, three or more than three specific drug classes)
- Pain relief: Pain relief profile for the major underlying pathologies (levels of pain relief for each underlying pathology)
- Interventional treatments: use of interventional treatments such as epidural injections, facet joint injections, facet joint denervation, large joint injections, medical acupuncture, nerve root blocks, peripheral nerve blocks, prolotherapy, sympathetic blocks, lumbar sympathectomy, spinal manipulation, trigger point injections, tendon sheath/bursa injections, intrathecal injection, spinal chord stimulation, intramuscular stimulation, TENS and others.
- Clinical issues and challenges in the treatment of NP: Individual responses from physicians to this question
- Selective serotonin reuptake inhibitors: First, second and third most frequently used
- Any other comments on the treatment of Neuropathic Pain: Individual responses from physicians to this question
- Serotonin-noradrenalin reuptake inhibitors: First, second and third most frequently used
- Anticonvulsants: First, second and third most frequently used
- Sodium Channel Blockers: First, second and third most frequently used
- Opioids: First, second and third most frequently used
1. Introduction
2. Study Design and Conduct
3. Study Participants
4. Interventional Treatments
5. Underlying Diagnoses
6. Single or Multiple Drugs
7. Drug Classes
8. Tricyclic Antidepressants
9. Selective Serotonin Reuptake Inhibitors
10. Serotonin Noradrenalin Reuptake Inhibitors
11. Anticonvulsants
12. Sodium Channel Blockers
13. Opioids
14. Non Steroidal Anti Inflammatory Drugs
15. Drug Combinations
16. Pain Relief
17. Use of Interventional Treatments
18. Discussion
19. Participant Details
Appendix 1
Appendix 2
Tables and Figures
Figure 3.1 Participant Countries
Figure 3.2 Participant Organisations
Figure 3.3 Participating Physicians
Figure 4.1 The use of interventional treatments by participating physicians
Figure 5.1 Percentage of physicians indicating that 20% or more of their patients’ Neuropathic Pain are associated with the diagnosis indicated
Figure 5.2 Mean percentage of physicians (Mean%p) who diagnosed NP in patients with specific underlying conditions
Figure 5.3 Neuropathic pain in patients associated with Diabetes
Figure 5.4 Neuropathic pain in patients associated with cancer radiotherapy or chemotherapy
Figure 5.5 Neuropathic pain in patients post general surgery
Figure 5.6 Neuropathic pain in patients with Trigeminal Neuralgia
Figure 5.7 Neuropathic pain in patients with viral infection
Figure 5.8 Neuropathic pain in patients with injury or trauma
Figure 5.9 Neuropathic pain in patients post back surgery
Figure 5.10 Neuropathic pain in patients with primary back problems
Figure 5.11 Neuropathic pain in patients with Complex Regional Pain Syndrome (CRPS)
Figure 5.12 Neuropathic pain in patients with Multiple Sclerosis
Figure 5.13 Neuropathic pain in patients with Central Pain
Figure 5.14 Neuropathic pain in patients with Arthritis
Figure 5.15 Neuropathic pain in patients with other conditions
Table 5.1 Other diagnoses associated with Neuropathic Pain
Table 6.1 Single drug use in the treatment of Neuropathic Pain
Table 6.2 Two drugs used in the treatment of Neuropathic Pain
Table 6.3 Three drugs used in the treatment of Neuropathic Pain
Table 6.4 More than three drugs used in the treatment of Neuropathic Pain
Table 6.5 Mean drug regimens in the treatment of Neuropathic Pain
Figure 7.1 Percentage of physicians prescribing the drug classes indicated, to more than 20% of their patients
Figure 7.2 The use of Tricyclic antidepressants in the treatment of Neuropathic Pain
Figure 7.3 The use of Selective Serotonin Reuptake Inhibitors (SSRIs) in the treatment of Neuropathic Pain
Figure 7.4 The use of Serotonin-Noradrenalin Reuptake Inhibitors (SNRIs) in the treatment of Neuropathic Pain
Figure 7.5 The use of Anticonvulsants in the treatment of Neuropathic Pain
Figure 7.6 The use of Sodium Channel Blockers in the treatment of Neuropathic Pain
Figure 7.7 The use of Opioids in the treatment of Neuropathic Pain
Figure 7.8 The use of Non-Steroidal Anti-inflammatory Drugs (NSAIDs) in the treatment of Neuropathic Pain
Figure 7.9 The use of Cannabinoids in the treatment of Neuropathic Pain
Figure 7.10 The use of Capsaicin in the treatment of Neuropathic Pain
Figure 7.11 Average drug class prescribing practices in the treatment of Neuropathic Pain
Figure 8.1 Most frequently prescribed tricyclic antidepressants in the treatment of Neuropathic Pain
Figure 8.2 Second most frequently prescribed tricyclic antidepressants in the treatment of Neuropathic Pain
Figure 8.3 Third most frequently prescribed tricyclic antidepressants in the treatment of Neuropathic Pain
Figure 9.1 Most frequently prescribed Selective Serotonin Reuptake Inhibitors (SSRIs) in the treatment of Neuropathic Pain
Figure 9.2 Second most frequently prescribed Selective Serotonin Reuptake Inhibitors (SSRIs) in the treatment of Neuropathic Pain
Figure 9.3 Third most frequently prescribed Selective Serotonin Reuptake Inhibitors (SSRIs) in the treatment of Neuropathic Pain
Figure 10.1 Most frequently prescribed Serotonin-Noradrenalin Reuptake Inhibitors (SNRIs) in the treatment of Neuropathic Pain
Figure 10.2 Second most frequently prescribed Serotonin-Noradrenalin Reuptake Inhibitors (SNRIs) in the treatment of Neuropathic Pain
Figure 10.3 Third most frequently prescribed Serotonin-Noradrenalin Reuptake Inhibitors (SNRIs) in the treatment of Neuropathic Pain
Figure 11.1 Most frequently prescribed Anticonvulsants in the treatment of Neuropathic Pain
Figure 11.2 Second most frequently prescribed Anticonvulsants in the treatment of Neuropathic Pain
Figure 11.3 Third most frequently prescribed Anticonvulsants in the treatment of Neuropathic Pain
Figure 12.1 Most frequently prescribed Sodium Channel Blockers in the treatment of Neuropathic Pain
Figure 12.2 Second most frequently prescribed Sodium Channel Blockers in the treatment of Neuropathic Pain
Figure 12.3 Third most frequently prescribed Sodium Channel Blockers in the treatment of Neuropathic Pain
Figure 13.1 Most frequently prescribed Opioids in the treatment of Neuropathic Pain
Figure 13.2 Second most frequently prescribed opioids in the treatment of Neuropathic Pain
Figure 13.3 Third most frequently prescribed opioids in the treatment of Neuropathic Pain
Figure 14.1 Most frequently prescribed Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the treatment of Neuropathic Pain
Figure 14.2 Second most frequently prescribed Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the treatment of Neuropathic Pain
Figure 14.3 Third most frequently prescribed Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the treatment of Neuropathic Pain
Table 15.1a Most frequently used drug class combinations for the treatment of Neuropathic Pain
Figure 15.1 Most frequently used drug class combinations for the treatment of Neuropathic Pain
Figure 15.2 Most frequently used numbers of drugs used in the treatment of Neuropathic Pain.
Table 15.2a Second most frequently used drug class combinations for the treatment of Neuropathic Pain.
Figure 15.3 Second most frequently used drug class combinations for the treatment of Neuropathic Pain.
Figure 15.4 Second most frequently used drug numbers used in the treatment of Neuropathic Pain.
Table 15.3a. Third most frequently used drug class combinations for the treatment of Neuropathic Pain.
Figure 15.5 Third most frequently used drug class combinations for the treatment of Neuropathic Pain.
Figure 15.6 Third most frequently used numbers of drugs in the treatment of Neuropathic Pain
Figure 16.1 Average relief from Neuropathic Pain (% reduction) following treatment in patients with Diabetes.
Figure 16.2 Average relief from Neuropathic Pain (% reduction) following treatment in patients with cancer radiotherapy or cancer chemotherapy
Figure 16.3 Average relief from Neuropathic Pain (% reduction) following treatment in patients following general surgery
Figure 16.4 Average relief from Neuropathic Pain (% reduction) following treatment in patients with Trigeminal Neuralgia
Figure 16.5 Average relief from Neuropathic Pain (% reduction) following treatment in patients with viral infection.
Figure 16.6 Average relief from Neuropathic Pain (% reduction) following treatment in patients with injury or trauma
Figure 16.7 Average relief from Neuropathic Pain (% reduction) following treatment in patients post back surgery.
Figure 16.8 Average relief from Neuropathic Pain (% reduction) following treatment in patients with primary back problems
Figure 16.9 Average relief from Neuropathic Pain (% reduction) following treatment in patients with Complex Regional Pain Syndrome (CRPS)
Figure 16.10 Average relief from Neuropathic Pain (% reduction) following treatment in patients with Multiple Sclerosis
Figure 16.11 Average relief from Neuropathic Pain (% reduction) following treatment in patients with Central Pain.
Figure 16.12 Average relief from Neuropathic Pain (% reduction) following treatment in patients with Arthritis.
Figure 16.13 Average relief from Neuropathic Pain (% reduction) following treatment in patients with other conditions.
Figure 16.14 Comparative average relief from NP (% reduction) following pain treatment in for all underlying conditions
Table 16.1 Comparative average relief from NP (% reduction) following pain treatment in for all underlying conditions
Figure 17.1 The percentage of physicians who use interventional treatments for Neuropathic Pain
Figure 17.2 The use of interventional treatments by physicians for Neuropathic Pain (number of practitioner responses for each treatment)
Figure 17.3 The use of interventional treatments by physicians for Neuropathic Pain (average % of physicians using treatments)
Table 17.1 The use of interventional treatments by physicians for Neuropathic Pain (number of practitioner responses for each treatment)
Table 17.2 The use of interventional treatments by physicians for Neuropathic Pain (average % of physicians using treatments)
Table 17.3 Other interventional treatments used by physicians for the treatment of Neuropathic Pain
Figure 19.1 Study participants
Appendices
Appendix 1. Responses of study participants to the question: What are the major issues and challenges associated with the treatment of neuropathic pain? Responses given by physicians to this question (which in some cases may be brief, informal or abbreviated) are presented “as is”, except in those cases where minor grammatical or typographical corrections have been necessary for reasons of clarity.
Appendix 2. Responses of study participants to the question: Any further comments relating to the treatment of Neuropathic Pain? Responses physicians to this question by physicians (which in some cases may be brief, informal or abbreviated) are presented “as is”, except in those cases where minor grammatical or typographical corrections have been necessary for reasons of clarity.
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