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Pain Therapeutics - Drugs, Markets and Companies Published on September 2011
Report 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 161 of these are profiled in the report along with 146 collaborations. These are a mix of pharmaceutical companies and biotechnology companies. The worldwide analgesic markets were analyzed for the year 2010 and projected to 2020. 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 65 tables, 18 figures, and 500 selected references to the literature.
Table of Content
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>> Get this Report Now by email! TABLE OF CONTENTS 0. Executive Summary 19 1. Basic Aspects of Pain 21 Introduction 21 Historical aspects of pain 21 Pain definitions 23 A glossary of terms relevant to pain 24 Pain classification and description 24 Neuropathic pain 25 Cancer pain 27 Bone pain in cancer 29 Complex regional pain syndrome 29 Mechanisms of pain 30 Pain pathways 30 Role of nociceptors in pain transmission 31 Gate control and neuromatrix theories of pain 32 Pain mediators 33 Modulation of pain by pictures associated with social contacts 33 Modulation of pain by emotions 33 Role of the sympathetic nervous system in pain 34 Visceral pain 34 Pathomechanism of visceral pain 34 Pathomechanism of neuropathic pain 35 Role of intact nerve fibers in neuropathic pain 35 Chemokines as mediators of neuropathic pain 35 Chemotherapy-induced neuropathic pain 36 CNS innate immunity and neuropathic pain 36 Cytokines as mediators of neuropathic pain 36 Free radicals in generation of neuropathic pain 36 Genetic basis of neuropathic pain 37 Gene expression changes in neuropathic pain 37 Glial activation and neuropathic pain 38 Immune cell-derived opioids and neuropathic pain 38 Spinal leptin and neuropathic pain 38 Tetrahydrobiopterin regulates neuropathic pain sensitivity 39 Pathomechanism of migraine 39 Role of the immune system in pain 40 Pain and itch 40 Pathomechanism of itch 40 Clinical aspects of itch 41 Molecular pathophysiology of pain 41 Role of ion channels in pain 41 Acid-sensing ion channels 42 Calcium channels in pain 42 P2X3 ion channels 43 Potassium ion channels 43 Sodium ion channels in pain 44
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