Stakeholder Insight: Neuropathic Low Back Pain - Off-label Revenue Despite Diagnostic Challenge
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- 1.1 Scope of the Analysis - page 3
- 1.2 Datamonitor insight into neuropathic low back pain - page 3
- Neuropathic low back pain affects an estimated 5.6 million people in the US alone. However, this type of back pain is rarely diagnosed and is poorly treated in the primary care setting. As such, there is strong need to educate physicians, especially PCPs, about the difference between the types of low back pain - page 4
- The most popular drug treatments of NLBP across the seven markets include gabapentin, amitriptyline and NSAIDs, which are often used in combination. However, there is little consensus as to best treatment practice between countries and even between physician types, which is compounded by the heterogeneity of patients and a dearth of randomized controlled trial data. A company can grow its share of the market by providing clear, convincing scientific data as either monotherapy or combination - page 5
- For at least the next five years generic gabapentin, NSAIDs, opioids, and antidepressants will continue to be the mainstay of NLBP management. Pfizer's successor to gabapentin, pregabalin will also play an important role. But the market is not entirely the reserve of generic companies and Pfizer. A significant commercial opportunity exists for medical device companies, although the biggest challenge is to change the physician perception that interventional treatment of NLBP is a modestly effective 'last resort'. - page 7
- 1.3 Neuropathic Low Back Pain Insight: methodology - page 9
- TABLE OF CONTENTS - page 10
- CHAPTER 2 INTRODUCTION - page 17
- CHAPTER 3 PATIENT POTENTIAL - page 18
- 3.1 Definition of neuropathic low back pain - page 18
- 3.2 Etiology - page 18
- Peripheral injury to non-neural tissue - page 18
- Peripheral injury to neural tissue - page 19
- 3.3 Epidemiology - page 20
- NLBP population across the seven major markets - page 20
- Prevalence of low back pain in the US - page 20
- Prevalence of low back pain in Germany - page 21
- Prevalence of low back pain in Spain - page 22
- Prevalence of low back pain in the UK - page 23
- Frequency of neuropathic low back pain - page 25
- Breakdown of pain severity by physician type - page 26
- CHAPTER 4 ASSESSMENT AND TREATMENT - page 30
- 4.1 Referral patterns - page 30
- Overview - page 30
- US - page 31
- Japan - page 32
- France - page 32
- Germany - page 33
- Italy - page 34
- Spain - page 34
- UK - page 35
- 4.2 Importance of therapeutic endpoints on prescribing decisions - page 36
- Overview - page 36
- US - page 38
- Japan - page 38
- France - page 39
- Germany - page 40
- Italy - page 41
- Spain - page 41
- UK - page 42
- 4.3 Pharmacotherapy - page 43
- Introduction - page 43
- 4.4 Treatment of neuropathic low back pain across the seven major markets - page 49
- Overview of commonly used drugs - page 49
- US - page 54
- Japan - page 60
- France - page 63
- Germany - page 67
- Italy - page 71
- Spain - page 74
- UK - page 77
- 4.5 The commercial potential of implantable systems - page 82
- Introduction - page 82
- Medtronic's Synergy neurostimulation system for NLBP - page 83
- Intrathecal pumps - page 83
- A niche market - page 85
- 4.6 Unmet needs - page 86
- More evidence based treatments - page 86
- Improved diagnosis and identifying treatment responders - page 87
- 4.1 Referral patterns - page 30
- CHAPTER 5 APPENDIX A - page 90
- 5.1 Bibliography - page 90
- References - page 90
- Websites - page 95
- 5.2 Contributing experts - page 95
- 5.3 Physician research methodology - page 98
- Introduction - page 98
- Our research partners - page 100
- Research objectives - page 101
- Questionnaire development - page 103
- Research methodology - page 103
- Data processing - page 106
- Quality control - page 106
- 5.4 Neuropathic Pain Insight Questionnaire - page 106
- 5.1 Bibliography - page 90
- CHAPTER 6 APPENDIX B - page 113
- 6.1 About Datamonitor - page 113
- About Datamonitor Healthcare - page 113
- Datamonitor Healthcare's research and analysis methodologies - page 114
- 6.2 Datamonitor Healthcare's therapy area capabilities - page 114
- About the CNS analysis team - page 115
- Datamonitor Healthcare's Consulting expertise - page 116
- Key therapy team members - page 117
- About the Author - page 118
- Disclaimer - page 120
- 6.1 About Datamonitor - page 113
- List of Tables
- Table 1: Sample size of the Neuropathic Low Back Pain Insight study - page 9
- Table 2: The NLBP patient population across the seven major markets, 2004 - page 20
- Table 3: NLBP referral patterns across the seven major markets, 2003 - page 30
- Table 4: Referral patterns of NLBP patients in the US, 2003 - page 31
- Table 5: Referral patterns of NLBP patients in Japan, 2003 - page 32
- Table 6: Referral patterns of NLBP patients in France, 2003 - page 32
- Table 7: Referral patterns of NLBP patients in Germany, 2003 - page 33
- Table 8: Referral patterns of NLBP patients in Italy, 2003 - page 34
- Table 9: Referral patterns of NLBP patients in Spain, 2003 - page 34
- Table 10: Referral patterns of NLBP patients in UK, 2003 - page 35
- Table 11: Importance of key therapeutic endpoints in NLBP according to US physicians, 2003 - page 38
- Table 12: Importance of key therapeutic endpoints in NLBP according to physicians in Japan, 2003 - page 39
- Table 13: Importance of key therapeutic endpoints in NLBP according to physicians in France, 2003 - page 39
- Table 14: Importance of key therapeutic endpoints in NLBP according to physicians in Germany, 2003 - page 40
- Table 15: Importance of key therapeutic endpoints in NLBP according to physicians in Italy, 2003 - page 41
- Table 16: Importance of key therapeutic endpoints in NLBP according to physicians in Spain, 2003 - page 42
- Table 17: Importance of key therapeutic endpoints in NLBP according to physicians in the UK, 2003 - page 43
- Table 18: Antidepressants used to treat NLBP - page 44
- Table 19: Anticonvulsants used to treat NLBP - page 46
- Table 20: Opioids used to treat NLBP - page 47
- Table 21: NSAIDs used to treat NLBP - page 48
- Table 22: Top ten first-line treatments of NLBP in the US, 2003 - page 57
- Table 23: Progression of NLBP patients to second-line therapy in the US, 2003 - page 57
- Table 24: Top ten most widely adopted second-line treatments of NLBP in the US, 2003 - page 58
- Table 25: Progression of NLBP patients to third-line therapy in the US, 2003 - page 58
- Table 26: Top ten most widely adopted third-line treatments of NLBP in the US, 2003 - page 59
- Table 27: Top ten first-line treatments of NLBP in Japan, 2003 - page 61
- Table 28: Progression of NLBP patients to second-line therapy in Japan, 2003 - page 61
- Table 29: Top ten most widely adopted second-line treatments of NLBP in Japan, 2003 - page 62
- Table 30: Progression of NLBP patients to third-line therapy in Japan, 2003 - page 62
- Table 31: Top ten most widely adopted third-line treatments of NLBP in Japan, 2003 - page 63
- Table 32: Top ten first-line treatments of NLBP in France, 2003 - page 64
- Table 33: Progression of NLBP patients to second-line therapy in France, 2003 - page 65
- Table 34: Top ten most widely adopted second-line treatments of NLBP in France, 2003 - page 66
- Table 35: Progression of NLBP patients to third-line therapy in France, 2003 - page 66
- Table 36: Top ten most widely adopted third-line treatments of NLBP in France, 2003 - page 67
- Table 37: Top ten first-line treatments of NLBP in Germany, 2003 - page 68
- Table 38: Progression of NLBP patients to second-line therapy in Germany, 2003 - page 69
- Table 39: Top ten most widely adopted second-line treatments of NLBP in Germany, 2003 - page 69
- Table 40: Progression of NLBP patients to third-line therapy in Germany, 2003 - page 70
- Table 41: Top ten most widely adopted third-line treatments of NLBP in Germany, 2003 - page 70
- Table 42: Top ten first-line treatments of NLBP in Italy, 2003 - page 72
- Table 43: Progression of NLBP patients to second-line therapy in Italy, 2003 - page 72
- Table 44: Top ten most widely adopted second-line treatments of NLBP in Italy, 2003 - page 73
- Table 45: Progression of NLBP patients to third-line therapy in Italy, 2003 - page 73
- Table 46: Top ten most widely adopted third-line treatments of NLBP in Italy, 2003 - page 74
- Table 47: Top ten first-line treatments of NLBP in Spain, 2003 - page 75
- Table 48: Progression of NLBP patients to second-line therapy in Spain, 2003 - page 76
- Table 49: Top ten most widely adopted second-line treatments of NLBP in Spain, 2003 - page 76
- Table 50: Progression of NLBP patients to third-line therapy in Spain, 2003 - page 77
- Table 51: Top ten most widely adopted third-line treatments of NLBP in Spain, 2003 - page 77
- Table 52: Top ten first-line treatments of NLBP in the UK, 2003 - page 79
- Table 53: Progression of NLBP patients to second-line therapy in the UK, 2003 - page 79
- Table 54: Top ten most widely adopted second-line treatments of NLBP in the UK, 2003 - page 80
- Table 55: Progression of NLBP patients to third-line therapy in the UK, 2003 - page 80
- Table 56: Top ten most widely adopted third-line treatments of NLBP in the UK, 2003 - page 81
- Table 57: Change in back and leg pain among patients treated with implantable drug-delivery systems - page 84
- Table 58: Stakeholder and Multiclient Insight Studies by Therapy Area, 2003 - page 99
- List of Figures
- Figure 1: Breakdown of NLBP patients by pain severity in the US, 2003 - page 26
- Figure 2: Breakdown of NLBP patients by pain severity in Japan, 2003 - page 27
- Figure 3: Breakdown of NLBP patients by pain severity in France, 2003 - page 27
- Figure 4: Breakdown of NLBP patients by pain severity in Germany, 2003 - page 28
- Figure 5: Breakdown of NLBP patients by pain severity in Italy, 2003 - page 28
- Figure 6: Breakdown of NLBP patients by pain severity in Spain, 2003 - page 29
- Figure 7: Breakdown of NLBP patients by pain severity in the UK, 2003 - page 29
- Figure 8: Importance of key therapeutic endpoints in NLBP, 2003 - page 36
- Figure 9: Top three most widely adopted first-line treatments of NLBP across the seven major markets, 2003 - page 50
- Figure 10: Summary of NLBP treatment in the US, 2003 - page 56
- Figure 11: Summary of NLBP treatment in Japan, 2003 - page 60
- Figure 12: Summary of NLBP treatment in France, 2003 - page 64
- Figure 13: Summary of NLBP treatment in Germany, 2003 - page 67
- Figure 14: Summary of NLBP treatment in Italy, 2003 - page 71
- Figure 15: Summary of NLBP treatment in Spain, 2003 - page 74
- Figure 16: Summary of NLBP treatment in the UK, 2003 - page 78
- Figure 17: Primary Research Process - page 100
- Figure 18: Datamonitor's Healthcare Consultancy - page 116
- Figure 19: Datamonitor Healthcare's Therapeutic Consulting capabilities - page 117
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