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Treating Neuropathic Pain: A Global Study of Clinical Strategies

This report presents the findings of a global survey on current therapeutic approaches to the treatment of Neuropathic Pain. These findings were made following the participation of more than 330 physicians, who provided details of their treatments and prescribing practices [Download full brochure]  The report is available along with an analysis of pipeline candidates for the treatment of pain here.

With estimated prevalence levels of 3-10%, the treatment of Neuropathic Pain remains an area of significant unmet need. Treatment 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 Neuropathic Pain. This background, the individual nature of Neuropathic Pain 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 Neuropathic Pain 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, this report has conducted an in-depth global survey on current treatments and drug prescribing practices, relating to Neuropathic Pain. This survey involved the participation of more than 330 physicians and clinical centres in 56 countries.

As part of this study, pain physicians were asked to described current limitations relating to the treatment of neuropathic pain. This report presents an an analysis of these findings, provided by more than 300 study participants.

Overview:

• Comprehensive details of current treatments for Neuropathic Pain, provided by more than 330 clinics in 56 countries
• In-depth information relevant to markets and opportunities in the Neuropathic Pain 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 Neuropathic Pain, seen in their patients
• Comprehensive information on the most frequently prescribed drugs from nine drugs classes, including drug combinations, for the treatment of Neuropathic Pain. The report suggest 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 Neuropathic Pain (e.g. peripheral nerve block, TENS)
• An assessment of average levels of pain relief achieved in the treatment of Neuropathic Pain, in relation to 12 underlying conditions
• Informative views of participating physicians on current limitations, challenges and issues relating to the treatment of Neuropathic Pain

Table of Contents

• 1. Introduction 12
• 2. Study Design and Conduct 15
• 3. Study Participants 21
• 4. Interventional Treatments 27
• 5. Underlying Diagnoses 31
• 6. Single or Multiple Drugs 41
• 7. Drug Classes 46
• 8. Tricyclic Antidepressants 53
• 9. Selective Serotonin Reuptake Inhibitors 56
• 10. Serotonin Noradrenalin Reuptake Inhibitors 60
• 11. Anticonvulsants 63
• 12. Sodium Channel Blockers 67
• 13. Opioids 70
• 14. Non Steroidal Anti Inflammatory Drugs 74
• 15. Drug Combinations 78
• 16. Pain Relief 91
• 17. Use of Interventional Treatments 101
• 18. Discussion 109
• 19. Participant Details 114

Appendix 1 118
Appendix 2 158

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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