Abstract
Summary
This report describes the latest concepts of pathomechanisms of pain as a
basis for management and development of new pharmacotherapies for pain. Major
segments of the pain market are arthritis, neuropathic pain and cancer pain.
Because pain is a subjective sensation, it is difficult to evaluate
objectively in clinical trials. Various tools for pain measurement are
described, including brain imaging.
Most of the currently used analgesic drugs fall into the categories of opioids
and nonsteroidal antiinflammatory drugs such as COX-2 inhibitors. Non-opioid
analgesics include ketamine, a N-methyl-D-aspartate receptor antagonist.
Adjuvant analgesics include antidepressants and antiepileptic drugs used for
the treatment of neuropathic pain. Management of pain is multidisciplinary and
includes both pharmacological and non-pharmacological methods such as
acupuncture, transcutaneous electrical nerve stimulation and surgery. Various
pain syndromes require different approaches in management, for example, the
main category of drugs for migraine are triptans such as sumatriptan.
Drug delivery is an important consideration in pain treatment. Controlled
release preparations provide a steady delivery of analgesics. Well-known
non-injection methods such astransdermal, pulmonary and intranasal application
have been used. Topical analgesics and local anesthetics are also available.
Devices such as implanted pumps are used for delivery of drugs such as opioids
intrathecally (introduction into spinal subarachnoid space by lumbar puncture)
in patients with cancer pain.
The wide variety of drugs in development includes opioid receptor ligands,
bradykinin antagonists, mPGES-1 inhibitors, glutamate receptor antagonists,
substance P and neurokinin receptor antagonists, norepinephrine transporter
inhibitors,P2X2 neuron receptor antagonists and nitric oxide-based analgesics.
A number of cannabinoids are also in development for pain. Fish-derived
tetrodotoxin was initially focused on indication of opiate addiction
withdrawal but is found to have an analgesic action as well. Cone shells
contain therapeutically useful peptides including the conotoxins, and one such
peptide, ziconotide, has been approved. Various cell and gene therapies are
also being developed for the management of pain.
Advances in molecular and biological techniques are markedly advancing our
undestanding of pain. Understanding the pathophysiology of pain is an
important factor in discovery of rational therapies for pain. Advances in
pharmacogenomics and pharmacogenetics are enabling the development of
personalized approaches to the management of pain.
Over 500 companies have been identified to be involved in developing or
marketing pain therapeutics and 150 of these are profiled in the report along
with 140 collaborations. These are a mix of pharmaceutical companies and
biotechnology companies.
The worldwide analgesic markets were analyzed for the year 2007 and projected
to 2017. Calculations are based on the epidemiology of various painful
conditions and the development of analgesic drugs and devices. Unfulfilled
needs for analgesics are identified and strategies are outlined to develop
markets for analgesic drugs.The report is supplemented with 63 tables, 18
figures, and 500 selected references to the literature.
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