Neuropathic Pain: Competing Treatments and Market Entry Considerations

BioPharm Reports (VennBio Ltd.), June 2010, Pages: 195

This report presents the findings of a global study of current therapeutic approaches to the treatment of Neuropathic Pain (NP). These findings were made following the participation of more than 330 clinics, who provided details of their treatments and prescribing practices. This was carried out as part of a competitor insight and market entry study, in the neuropathic pain field.

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.

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

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

Report Figures and Tables

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

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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