US Neuropathic Pain 2008, 4th Edition

Table of Contents

Two new indications:

• Fibromyalgia
• Neuropathic Cancer Pain

I. EXECUTIVE SUMMARY

II. INTRODUCTION AND METHODOLOGY

III. PHYSIOLOGY OF PAIN

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

IV. CLINICAL ASSESSMENT OF NEUROPATHIC PAIN

• 1. Qualitative description of pain
• 2. Standard quantitative pain measurement scales
• 3. Physical examination of the neuropathic pain patient

V. EPIDEMIOLOGY - CURRENT AND FUTURE

• A. Neuropathic Low-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. US neuropathic, chronic low-back pain population forecasts
• B. Diabetic Neuropathy
  • 1. Diabetic neuropathy
  • 2. Diabetes prevalence
  • 3. Diabetic neuropathy prevalence
  • 4. Painful diabetic neuropathy prevalence
  • 5. Moderate-to-severe diabetic neuropathic pain prevalence
  • 6. Chronic moderate-to-severe diabetic neuropathic pain prevalence
  • 7. Basis of target population forecasts
  • 8. US diabetic neuropathy population forecasts
• C. 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. US CRPS population forecasts
• D. HIV/AIDS Neuropathic Pain
  • 1. HIV/AIDS pain
  • 2. AIDS incidence and prevalence
  • 3. HIV (not AIDS) prevalence
  • 4. HIV/AIDS pain prevalence
  • 5. HIV/AIDS neuropathic pain prevalence
  • 6. Basis of target population forecasts
  • 7. US HIV/AIDS neuropathy population forecasts
• E. Post-Herpetic Neuralgia
  • 1. Post-herpetic neuralgia
  • 2. Herpes zoster incidence
  • 3. Post-herpetic neuralgia incidence
  • 4. Incidence of persistent post-herpetic neuralgia
  • 5. Persistent post-herpetic neuralgia prevalence
  • 6. Basis of target population forecasts
  • 7. US post-herpetic neuralgia population forecasts
• F. 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. US phantom limb pain population forecasts
• G. 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. US spinal cord injury population forecasts
• H. Trigeminal Neuralgia
  • 1. Trigeminal neuralgia
  • 2. Trigeminal neuralgia incidence and prevalence
  • 3. Basis for target population
  • 4. US trigeminal neuralgia population forecasts
• I. Neuropathic Cancer Pain
  • 1. Cancer pain
  • 2. Incidence of cancer
  • 3. Incidence of neuropathic cancer pain
  • 4. Prevalence of neuropathic cancer pain
  • 5. Basis for target population
  • 6. US Neuropathic cancer pain population forecasts
• J. Fibromyalgia
  • 1. Fibromyalgia
  • 2. Incidence of fibromyalgia
  • 3. Prevalence of fibromyalgia
  • 4. Diagnosed and treated population
  • 5. Basis for target population
  • 6. US fibromyalgia population forecasts

VI. APPROACHES TO TREATMENT OF NEUROPATHIC PAIN

• A. 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
• B. Clinical Practice Guidelines
• C. Limitations of Current Treatment
• D. Promising New Approaches
• E. Future Trends
• F. Drugs in Clinical Development to Treat Neuropathic Pain
  • 1. Recent launches/approvals
  • 2. Current pipeline
    • 2.1 Phase III, Preregistration, and Registration
    • 2.2 Phase II
    • 2.3 Phase I
    • 2.4 Discontinued or suspended drugs
    • 2.5 Marketed agents with significant off-label usage for NP

VII. MARKET FORECASTS AND ESTIMATES, CURRENT AND FUTURE

• A. Current Sales of Pharmaceutical Products, By Drug Class and Condition
  • 1. 2008 US market: summary by drug class
    • 1.1 Anticonvulsants
    • 1.2 Oral opioids
    • 1.3 Antidepressants
    • 1.4 Other drug classes
  • 2. 2008 US market: summary by neuropathic pain condition
    • 2.1 Fibromyalgia
    • 2.2 Neuropathic back pain
    • 2.3 Diabetic neuropathy (DN)
    • 2.4 Neuropathic cancer pain
    • 2.5 Post-herpetic neuralgia (PHN)
    • 2.6 Complex regional pain syndrome (CRPS)
    • 2.7 Trigeminal neuralgia (TN)
    • 2.8 Phantom limb pain
    • 2.9 HIV/AIDS neuropathic pain
    • 2.10 Spinal cord injury
  • Methodology
• B. Market Forecast for Neuropathic Pain