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Pain Therapeutics 2005

 

Overview

Pain Therapeutics 2005: Market Dynamics and Outlook provides detailed analysis and information concerning the global market for pain therapeutics, R&D pipelines and company involvement in this field.

About one and a half billion people suffer from moderate to severe chronic pain worldwide and approximately 50 million Americans suffer with pain. The value of the pharmaceutical market for pain relief reflects this seeming worldwide epidemic of pain, with the overall value reaching nearly $23 billion in 2004.

In this report, key pain management therapeutics such as Cox-II inhibitors, opioids, triptans, anticonvulsants and traditional NSAIDs are discussed in terms of their past, present and future value and the role they are playing in the effective management of pain.

The dynamics of this market have been altered greatly over the past year. The troubles surrounding the multi-billion dollar Cox-II class has created a void in the marketplace. Pain Therapeutics 2005 explains just what the Cox-II crisis means for the future of pain management and what kinds of opportunities their failure may present for other classes of pain management medications.

Pain Therapeutics 2005 also analyzes the markets and provides forecasts for:

• the fast-growing anticonvulsant class
• migraine therapies
• traditional NSAIDs
• and opioids.

This 249-page report also includes the following features:

• 93 tables/graphs which provide the reader with valuable illustrated insight into trends and issues affecting this growing market.

• Thorough financial breakdown of the leading products and companies making an impact on the pain market

• Identification and discussion of trends and issues that are pushing the market into the future.

• Profiles of key companies involved in the development and marketing of pain therapeutics

• Forecasts of key products/classes

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Table of Contents

• Table of Contents
• 1 Methodology and Executive Summary
  • 1.1 Report Objectives and Scope
  • 1.2 Research Methodology
  • 1.3 Executive Summary
  • 2 Causes, Classifications and Global Impact of Pain
    • 2.1 Causes
      • 2.1.1 Terminal Illness
      • 2.1.2 Pain and Genetics
      • 2.1.3 The Immune System and Pain
      • 2.1.4 The Subjective Nature of Pain
      • 2.1.5 Pain Transmission
        • 2.1.5.1 Nociceptors
        • 2.1.5.2 Pain Receptors
    • 2.2 Classifications
      • 2.2.1 Chronic Pain
      • 2.2.2 Acute Pain
    • 2.3 The Impact of Pain
      • 2.3.1 Demographic Impact
      • 2.3.2 Financial Cost of Pain
  • 3 Treating Pain: Drug Classes and Guidelines
    • 3.1 NSAIDs
    • 3.2 Opioids
      • 3.2.1 Chronic Pain and Opioids
    • 3.3 Antidepressants
    • 3.4 Anticonvulsants
  • 4 Post-Operative Pain Overview and Therapeutic Options
    • 4.1 Impact of Post-Operative Pain
    • 4.2 Pain Intensity in Surgical Sites
    • 4.3 Site-specific Pain Relief
    • 4.4 Postoperative Medications
      • 4.4.1 Naropin
      • 4.4.2 DepoDur, DepoMorphine and Propofol
      • 4.4.3 Other Opioids for Pain Management
      • 4.4.4 NSAIDs for Postoperative Pain
  • 5 Back Pain Overview and Therapeutic Options
    • 5.1 Sciatica
    • 5.2 Facet Joint Problems
    • 5.3 Osteoarthritis
    • 5.4 Diseases and Back Pain
    • 5.5 Low Back Pain
    • 5.6 Pharmaceutical Relief for Back Pain
      • 5.6.1 Transdermal Patches
      • 5.6.2 Injections for Back Pain
      • 5.6.3 Back Pain and Opioids
      • 5.6.4 Tricyclic Antidepressants
      • 5.6.5 Muscle Relaxers
      • 5.6.6 Colchicine
      • 5.6.7 Chronic Low Back Pain and Anticonvulsants
  • 6 Neuropathic Pain Overview and Therapeutic Options
    • 6.1 Nociceptive Versus Neuropathic Pain
    • 6.2 Nociceptive and Neuropathic Mixed Pain
    • 6.3 Neuropathic Pain
    • 6.4 Neuropathic Pain Generation
    • 6.5 Treating Neuropathic Pain
      • 6.5.1 Transdermal Fentanyl
      • 6.5.2 Ketamine and Alfentanil
      • 6.5.3 Neurontin
      • 6.5.4 Lyrica
  • 7 Migraine Overview and Therapeutic Options
    • 7.1 Impact of Migraines
    • 7.2 Pharmacological Treatment of Migraine Pain
      • 7.2.1 Fiorinal and Fioricet
      • 7.2.2 Ergot Alkaloid Derivatives
      • 7.2.3 Triptans
        • 7.2.3.1 Comparing Triptans
        • 7.2.3.2 Imitrex
        • 7.2.3.3 Zomig
        • 7.2.3.4 Maxalt
        • 7.2.3.5 Relpax
      • 7.2.4 Neuroleptics
      • 7.2.5 Beta-blockers
    • 7.3 New and Investigational Drugs for Migraine Pain
      • 7.3.1 Topamax
      • 7.3.2 Alexza
      • 7.3.3 Botox
      • 7.3.4 Trexima
    • 7.4 Alternative Therapies for Migraine
  • 8 Cancer Pain Overview and Therapeutic Options
    • 8.1 Causes of Cancer Pain
    • 8.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Cancer Pain
    • 8.3 Opioids and Cancer Pain
      • 8.3.1 Reluctance to Prescribe Opioids
    • 8.4 Seizure Drugs for Cancer Pain
    • 8.5 Investigational Drugs
      • 8.5.1 Remoxy
      • 8.5.2 Ziconatide
      • 8.5.3 Chronogesic Pain Therapy System
      • 8.5.4 Xen2174
  • 9 Arthritic Pain Overview and Therapeutic Options
    • 9.1 Impact of Arthritis
    • 9.2 Rheumatoid Arthritis
      • 9.2.1 Causes
      • 9.2.2 RA Demographics
      • 9.2.3 Genetic Susceptibility
      • 9.2.4 Environmental Factors
      • 9.2.5 High Cost of Rheumatoid Arthritis
    • 9.3 Osteoarthritis
      • 9.3.1 Causes
      • 9.3.2 Pharmacological Treatment of Osteoarthritis
        • 9.3.2.1 COX-2 Class
      • 9.3.3 Pharmacological Treatment of Rheumatoid Arthritis
    • 9.4 Antirheumatic Drug Classes
      • 9.4.1 Nonsteroidal Anti-Inflammatory Drugs
      • 9.4.2 Corticosteroids
      • 9.4.3 Disease Modifying Anti-Rheumatic Drugs (DMARDs)
      • 9.4.4 DMARD Competition
      • 9.4.5 Slow-Acting Antirheumatic Drugs (SAARDs)
      • 9.4.6 Biological Response Modifiers (BRMs)
      • 9.4.7 Leading RA Medications
      • 9.4.8 BRMs Versus DMARDs
  • 10 Fibromyalgia Overview and Therapeutic Options
    • 10.1 Manifestations
    • 10.2 Impact of Fibromyalgia
    • 10.3 Natural Treatments for Fibromyalgia
    • 10.4 Prescription Treatments for Fibromyalgia
      • 10.4.1 Treatment with Antidepressants
      • 10.4.2 Muscle Relaxants
      • 10.4.3 Sleep Modifiers
      • 10.4.4 Anxiety Medications
      • 10.4.5 Anticonvulsants
      • 10.4.6 Antibiotics
    • 10.5 Future Therapies for Fibromyalgia
  • 11 Non-Pharmaceutical Pain Treatment
    • 11.1 Acupuncture
      • 11.1.1 Assessing Acupuncture�s Value
    • 11.2 Osteopathic Manipulation
      • 11.2.1 Osteopathic Treatment
      • 11.2.2 Conditions Treated by Osteopaths
    • 11.3 Physiotherapy
    • 11.4 Reflexology
    • 11.5 Neurostructural Integration Technique
    • 11.6 Herbal medicine
    • 11.7 Neurolytic Block Injections
      • 11.7.1 Examples of Neurolytic Blocks
    • 11.8 Chemical Neurolytic Blocks
    • 11.9 Cryoablation
    • 11.10 Radiofrequency Lesioning
    • 11.11 Neurosurgical Procedures
    • 11.12 Chemical Ablation
    • 11.13 Nerve Blocks
    • 11.14 Neurostimulation and Pain Control
    • 11.15 Electro Thermal Disc Decompression/ Intradiscal Electro Thermocoagulation
    • 11.16 Selective Nerve Root Injections
    • 11.17 Facet Joint Pain Block
    • 11.18 Trigger Spot Injections
    • 11.19 Peripheral Nerve Injections
    • 11.20 Cervical and Lumbar Epidural Blocks
  • 12 NSAID Market Analysis
    • 12.1 Overview
    • 12.2 Over-the-Counter NSAIDs
      • 12.2.1 Ibuprofen
      • 12.2.2 Naproxen
      • 12.2.3 Acetaminophen and Aspirin
    • 12.3 Traditional Prescription NSAIDs
      • 12.3.1 Diclofenac/Cataflam/Voltaren
      • 12.3.2 Arthrotec
      • 12.3.3 Mobic
        • 12.3.3.1 Mobic�s Market Share
        • 12.3.3.2 Mobic Vs Other NSAIDs
      • 12.3.4 DayPro
        • 12.3.4.1 Rheumatoid Arthritis Relief from DayPro
        • 12.3.4.2 Osteoarthritis Relief from DayPro
      • 12.3.5 Relafen
        • 12.3.5.1 Relafen Versus Naproxen and Aspirin
        • 12.3.5.2 Endoscopy Trials
    • 12.4 The Future of the NSAID Market
  • 13 Opioid Use and Market Trends
    • 13.1 Drawbacks of Opioid Therapy
    • 13.2 Treating Chronic Pain
    • 13.3 Key Opioid Products
      • 13.3.1 Morphine
        • 13.3.1.1 Increased Usage of Morphine
        • 13.3.1.2 Cognitive and Psychomotor Effects
        • 13.3.1.3 Extended Release Morphine
      • 13.3.2 Oxycodone
      • 13.3.3 Kadian
        • 13.3.3.1 Key Clinical Trial
      • 13.3.4 Vicodin
      • 13.3.5 Ultracet/Ultram
      • 13.3.6 Duragesic
    • 13.4 Legal Regulation of Opioids
    • 13.5 Side Effects
    • 13.6 Adjuvant Medications
    • 13.7 Market Analysis
      • 13.7.1 OxyContin
      • 13.7.2 Duragesic
      • 13.7.3 Kadian
      • 13.7.4 Ultracet/Ultram
      • 13.7.5 Avinza
      • 13.7.6 Actiq
    • 13.8 Key Opioid Products in Development
      • 13.8.1 Chronogesic
      • 13.8.2 Ionsys
      • 13.8.3 Remoxy
    • 13.9 The Future of the Opioid Market
  • 14 Migraine Therapy Market
    • 14.1 Overview
    • 14.2 Leading Migraine Therapies
      • 14.2.1 Imitrex/Imigran
      • 14.2.2 Zomig
      • 14.2.3 Relpax
      • 14.2.4 Maxalt
    • 14.3 Preventive vs. Abortive Therapy
    • 14.4 The Future of the Migraine Market
  • 15 Anticonvulsant Market
    • 15.1 Overview
    • 15.2 Leading Anticonvulsants
      • 15.2.1 Neurontin
        • 15.2.1.1 Generic Competition
      • 15.2.2 Topamax
      • 15.2.3 Depakote
      • 15.2.4 Lamictal
      • 15.2.5 Trileptal
      • 15.2.6 Tegretol
    • 15.3 The Future of the Anticonvulsant Market
  • 16 Cox-II Inhibitors and the Future
    • 16.1 The Fall of Bextra
      • 16.1.1 Health Risks Alert
      • 16.1.2 Thromboembolic Events
      • 16.1.3 Post-marketing Reports for Bextra
      • 16.1.4 Withdrawal of Bextra
    • 16.2 The Fall of Vioxx
      • 16.2.1 Public Health Advisory
      • 16.2.2 Repercussions from the Vioxx Withdrawal
      • 16.2.3 Fear of COX-2 Inhibitors
      • 16.2.4 Financial Fallout for Merck
      • 16.2.5 Vioxx vs Other Cox-2 Inhibitors
    • 16.3 Celebrex: Surviving the Fallout
      • 16.3.1 FDA Review of Clinical Trials
      • 16.3.2 Black Box Warning
    • 16.4 Future Scrutiny of Cox-2 Class
    • 16.5 COX-2 Pipeline
      • 16.5.1 Prexige
        • 16.5.1.1 TARGET Assessment
      • 16.5.2 Arcoxia
        • 16.5.2.1 Future of Arcoxia
      • 16.5.3 Dynastat
    • 16.6 The Future of the Cox-II Class
  • 17 Promising Areas of Research
    • 17.1 Natural Painkillers
      • 17.1.1 Peptides
      • 17.1.2 Epibatidine
      • 17.1.3 Chili Peppers and Capsaicin
      • 17.1.4 Marijuana
      • 17.1.5 Receptors as Gateways
      • 17.1.6 Chromaffin Cells
      • 17.1.7 Glutamate
      • 17.1.8 Prialt
      • 17.1.9 New Class of Analgesics
  • 18 Company Briefs
• Abbott Laboratories
• AlgoRx Pharmaceuticals
• Altea Therapeutics
• Ardent Pharmaceuticals
• AstraZeneca
• Cephalon
• Elan Pharmaceuticals
• Endo Pharmacuticals
• EpiCept
• GlaxoSmithKline
• Indevus Pharmaceuticals
• Innovative Drug Delivery Systems
• Johnson & Johnson
• Metaphore Pharmaceuticals
• Nastech Pharmaceutical
• NeurogesX
• Novartis Pharmaceuticals
• Pain Therapeutics
• Pfizer
• Purdue
• Renovis
• SkyePharma
• Tables and Graphs
• Table 1.1 Value of the Pain Market, by Therapeutic Class 2004
• Graph 1.1 Value of the Pain Market, by Therapeutic Class Market Share 2004
• Table 1.2 Top Ten Pain Medications Worldwide in 2004
• Graph 1.2 Fastest Growing Pain Medication Classes, by Growth Rate
• Table 1.3 Key Patent Expirations for Pain Therapies
• Table 2.1 Characteristics and Treatment of Acute vs Chronic Pain
• Graph 2.1 Top Causes of Pain
• Table 2.2 Incidence of pain conditions in American households
• Table 3.1 Key Pain Management Drug Classes and Diseases/Conditions Treated
• Table 3.2 NSAID Delivery Routes
• Table3.3 Traditional NSAIDs
• Table 3.4 The Oxford League Table of Analgesic Efficacy
• Table 3.5 Well Known Narcotic Analgesics
• Table 3.6 WHO Guidelines for Pain Therapy
• Table 4.1 WFSA Analgesic Ladder
• Table 6.1 Department of Health and Human Services Assistive Tool for Determining Type of Pain
• Table 7.1 Estimated annual costs of migraine for the total population of patients with migraine
• Table 7.2 Popular Medicines for the Treatment of Migraines
• Table 7.3 Preventive Headache Therapies
• Table 7.4 Common Analgesics Prescribed for Migraine Pain
• Table 7.5 Ergot Alkaloid Derivatives for Migraine Pain Spray
• Table 7.6 NSAIDs and COX-2 Inhibitors
• Table 7.7 Triptans for Migraine Pain
• Table 7.8 Patent Expirations for Leading Triptans
• Table 7.9 Migraine Drugs In Development
• Table 8.1 Cancer Pain and Therapeutic Options
• Table 8.2 Adjuvants to Opioids for Treating Cancer Pain
• Table 9.1 Leading Causes of Disabilities in the US
• Table 9.2 Approved DMARDs for Rheumatoid Arthritis
• Table 9.3 Profiles of the Leading DMARDs
• Table 9.4 Sales of Biologics for Rheumatoid Arthritis, 1999-2004
• Graph 9.1 Growth of Biologics for Rheumatoid Arthritis 2000-2004
• Table 10.1 Popular Treatments for Fibromyalgia
• Table 11.1 Complementary and Alternative Medicine Use by U.S. Adults—2002
• Table 11.2 10 Most Common Complementary and Alternative Therapies 2002
• Table 11.3 Disease/Condition for Which Complementary/Alternative Medicines are Most Frequently Used
• Table 12.1 Global Sales of Leading Prescription NSAIDs (Traditional) 2004
• Graph 12.1 Prescription NSAID Product Market Share (traditional vs Cox-2 Inhibitors) 2004
• Graph 12.2 Prescription NSAID Product Market Share 2004
• Table 12.2 Sales of Advil 2002-2004
• Table 12.3 Sales of Aleve 2002-2004
• Table 12.4 Sales of Excedrin 2002-2004
• Table 12.5 Rejuvenation of Mobic Sales 2003-2004
• Table 12.6 Adverse Events (%) Occurring in 2% of MOBIC Patients in a 12-Week Osteoarthritis Placebo and Active-Controlled Trial
• Table 12.7 Traditional NSAIDs and Past Sales (Pre-Cox 2) 1998-1999
• Table 13.1 Key Opioid Product Sales 2004
• Graph 13.1 Global Market Share of Branded Opioid Products 2004
• Table 13.2 Sales Growth in the US Opioids Market 1997-2002
• Graph 13.2 Sales Growth in the US Opioids Market 1997-2004
• Table 13.3 Consumer cost of analgesics and adjuvants (2000) Medication Size Cost
• Table 13.4 Sales of OxyContin 2003-2004
• Table 13.5 Sales of Duragesic 2001-2004
• Graph 13.3 The Success of Duragesic: Global Sales 2001-2004
• Table 13.6 Sales of Kadian 2002-2004
• Table 13.7 Sales of Ultracet/Ultram 2001-2003
• Table 13.8 Sales of Avinza 2003-2004
• Table 13.9 Sales of Actiq 2002-2004
• Table 13.10 Financial Forecast of the Global Opioid Market 2004-2009
• Table 14.1 Sales of Triptan Drugs 2001-2004
• Graph 14.1 Sales of Triptan Drugs 2001-2004
• Table 14.2 Sales of Leading Migraine Therapies 2004
• Graph 14.2 Leading Migraine Therapies, Market Share 2004
• Graph 14.3 Geographic Market Share of Leading Triptan-Based Migraine Therapies 2004
• Table 14.3 Global Sales of Imitrex/Imigran 2001-2004
• Table 14.4 Global Sales of Zomig 2001-2004
• Table 14.5 Global Sales of Relpax 2001-2004
• Table 14.6 Global Sales of Maxalt 2001-2004
• Table 14.7 Financial Forecast of Triptans 2005-2009
• Table 15.1 Leading Anticonvulsants, Global Sales 2004
• Graph 15.1 Leading Anticonvulsants, Market Share 2004
• Table 15.2 Sales Growth in the Anticonvulsants Market 2001-2004
• Graph 15.2 Sales Growth in the Anticonvulsants Market 2001-2004
• Table 15.3 Leading Anticonvulsant Indications
• Table 15.3 Global Sales of Neurontin 2001-2004
• Table 15.4 Global Sales of Topamax 2001-2004
• Table 15.5 Global Sales of Depakote 2001-2004
• Table 15.6 Global Sales of Lamictal 2001-2004
• Table 15.7 Global Sales of Trileptal 2001-2004
• Table 15.8 Global Sales of Tegretol 2001-2004
• Table 15.9 Financial Forecast of the Anticonvulsant Market 2004-2009
• Table 16.1 Leading COX-2 Inhibitors 2004
• Table 16.2 Post-Bextra Switching Trends
• Table 16.3 Future Sales of Celebrex
• Table 18.1 The Value of Pfizer�s Pain Management Portfolio 2004 ($ mn)
• Table 18.2 Purdue Pharma�s Prescription Pain Portfolio
• Appendices
• Table I Global Sales of Leading Pain Management Drugs 2004
• Table II Pain Management Pipeline
• Table III Acute Pain Pipeline
• Table IV Chronic Pain Pipeline
• Table V Neuropathic Pain Pipeline
• Table VI Post-operative Pain Pipeline
• Table VII Severe Pain Pipeline
• Table IX NSAIDs Affected by Newly Required Warning Labels
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