Neuropathic Pain - A Commercial & Clinical Assessment

Table of Contents

EXECUTIVE SUMMARY

I. INTRODUCTION AND METHODOLOGY

II. PHYSIOLOGY OF PAIN

1. Definition of Neuropathic Pain
   1. Nerve injury
   2. Long duration
   3. Abnormal sensations
   4. Aggravation by physiological processes
   5. Cellular mechanisms of neuropathic pain
2. Definition of Neuropathic Pain States
   1. Diabetic neuropathy
   2. Post-herpetic neuralgia
   3. Peripheral neuropathy in HIV/AIDS
   4. Neuropathic low-back pain
   5. Trigeminal neuralgia (tic douloureux)
   6. Complex regional pain syndrome (CRPS)
   7. Phantom limb pain
   8. Spinal cord injury

III. MEASUREMENT OF PAINFUL CONDITIONS

1. Pain Measurement Scales
   1. Qualitative assessments
   2. Standard quantitative pain measurement scales
      1. Visual analog scale (VAS)
      2. McGill Pain Questionnaire (MPQ)
      3. The neuropathic pain scale (NPS)
2. Clinical Assessment of Neuropathic Pain

IV. EPIDEMIOLOGY - CURRENT AND FUTURE

1. Diabetic Neuropathy
   1. Diabetic neuropathy
   2. Diabetes prevalence
   3. Diabetic neuropathy prevalence
   4. Symptomatic diabetic neuropathy prevalence
   5. Diabetic neuropathic pain prevalence
   6. Basis of target population projections
   7. U.S. diabetic neuropathy population projections
2. Post-Herpetic Neuralgia
   1. Post-herpetic neuralgia
   2. Herpes zoster incidence
   3. Post-herpetic neuralgia incidence
   4. Post-herpetic neuralgia prevalence
   5. Basis of target population projections
   6. U.S. post-herpetic neuralgia population projections
3. HIV/AIDS Neuropathic Pain
   1. HIV/AIDS pain
   2. HIV/AIDS incidence and prevalence
   3. AIDS incidence and prevalence
   4. HIV/AIDS pain prevalence
   5. HIV/AIDS neuropathic pain prevalence
   6. Basis of target population projections
   7. U.S. HIV/AIDS neuropathy population projections
4. Neuropathic Back Pain
   1. Low-back pain
   2. Low-back pain incidence and prevalence
   3. Chronic low-back pain prevalence
   4. Neuropathic, chronic low-back pain prevalence
   5. Basis of target population
   6. U.S. neuropathic, chronic low-back pain population projections
5. Trigeminal Neuralgia
   1. Trigeminal neuralgia
   2. Incidence
   3. Basis for target population
   4. U.S. trigeminal neuralgia population projections
6. Complex Regional Pain Syndrome
   1. Complex regional pain syndrome
   2. Complex regional pain syndrome prevalence
   3. Complex regional pain syndrome severity
   4. Basis of target population estimation
   5. U.S. CRPS population projections
7. Phantom Limb Pain
   1. Phantom limb pain
   2. Amputation incidence and prevalence
   3. Phantom limb pain incidence and prevalence
   4. Basis of target population estimation
   5. U.S. phantom limb pain population projections
8. Spinal Cord Injury
   1. Spinal cord injury
   2. Spinal cord injury incidence
   3. Spinal cord injury prevalence
   4. Spinal cord injury chronic pain prevalence
   5. Basis of target population estimation
   6. U.S. spinal cord injury population projections

V. APPROACHES TO TREATMENT OF NEUROPATHIC PAIN

1. Actual Clinical Practice
   1. Antidepressants
   2. Anticonvulsants
   3. Local anesthetics, regional nerve blocks, and sympathetic nerve blocks
   4. Antiarrhythmics
   5. Non-narcotic synthetic opioids
   6. Opioids and semi-synthetic narcotics
   7. Muscle relaxants
   8. NMDA receptor antagonists
   9. Steroids
   10. VR-1 receptor agonists
   11. Non-steroidal anti-inflammatory agents (NSAIDS)
   12. Non-pharmacologic treatments
       1. Electrical nerve stimulation
       2. Acupuncture
       3. Hypnosis and psychological approaches
2. Clinical Practice Guidelines
3. Limitations of Current Treatment
4. Promising New Approaches
5. Future Trends
6. Drugs in Clinical Development to Treat Neuropathic Pain
   1. Recent changes in the pipeline
      1. Recent launches
      2. Drugs recently entering clinical trials
      3. Discontinued or suspended drugs
   2. Phase III, Preregistration, and Registration
      1. Ion channel antagonists
      2. Glutamate receptor antagonists
      3. Neuromuscular blocking agents
      4. Cannabinoid receptor agonists
      5. Growth factor agonist
      6. Alpha Adrenoreceptor agonists
   3. Phase II
      1. Glutamate/NMDA receptor antagonists
      2. Growth factor agonists
      3. Undefined mechanisms
      4. Ion channel antagonists
      5. GABA receptor agonists
      6. Cannabinoid receptor agonists
      7. Nicotinic acetylcholine receptor agonists
      8. Prostaglandin antagonists
      9. Cholecystokinin antagonists
      10. Cyclo-oxygenase inhibitors
   4. Phase I
      1. NMDA antagonists
      2. Adenosine A1 receptor antagonists
      3. Unknown mechanisms
   5. Unreported development status

VI. MARKET FORECASTS AND ESTIMATES, CURRENT AND FUTURE

1. Current Sales of Pharmaceutical Products, By Condition
   1. 2002 U.S. market: Summary by drug class
   2. 2002 U.S. market: Summary by neuropathic pain condition
      1. Clinician views
   3. 2002 U.S. market: Details by pain condition
      1. Diabetic neuropathic pain
      2. HIV/AIDS neuropathic pain
      3. Post-herpetic neuralgia
      4. Neuropathic back pain
      5. Trigeminal neuralgia
      6. Complex regional pain syndrome (CRPS)
      7. Phantom limb pain
      8. Spinal cord injury
2. Market Forecasts from 2002 - 2012 for Neuropathic Pain Treatment