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Pain Therapeutics 2005: Market Dynamics and Outlook provides detailed analysis and information concerning the global market for pain therapeutics, R&D pipelines and company involvement in this field.
About one and a half billion people suffer from moderate to severe chronic pain worldwide and approximately 50 million Americans suffer with pain. The value of the pharmaceutical market for pain relief reflects this seeming worldwide epidemic of pain, with the overall value reaching nearly $23 billion in 2004.
In this new report, key pain management therapeutics such as Cox-II inhibitors, opioids, triptans, anticonvulsants and traditional NSAIDs are discussed in terms of their past, present and future value and the role they are playing in the effective management of pain.
The dynamics of this market have been altered greatly over the past year. The troubles surrounding the multi-billion dollar Cox-II class has created a void in the marketplace. Pain Therapeutics 2005 explains just what the Cox-II crisis means for the future of pain management and what kinds of opportunities their failure may present for other classes of pain management medications.
Pain Therapeutics 2005 also analyzes the markets and provides forecasts for:
• the fast-growing anticonvulsant class
• migraine therapies
• traditional NSAIDs
• and opioids.
This 249-page report also includes the following features:
• 93 tables/graphs which provide the reader with valuable illustrated insight into trends and issues affecting this growing market.
• Thorough financial breakdown of the leading products and companies making an impact on the pain market
• Identification and discussion of trends and issues that are pushing the market into the future.
• Profiles of key companies involved in the development and marketing of pain therapeutics
• Forecasts of key products/classes

1 Methodology and Executive Summary
1.1 Report Objectives and Scope
1.2 Research Methodology
1.3 Executive Summary

2 Causes, Classifications and Global Impact of Pain
2.1 Causes
2.1.1 Terminal Illness
2.1.2 Pain and Genetics
2.1.3 The Immune System and Pain
2.1.4 The Subjective Nature of Pain
2.1.5 Pain Transmission
2.1.5.1 Nociceptors
2.1.5.2 Pain Receptors
2.2 Classifications
2.2.1 Chronic Pain
2.2.2 Acute Pain
2.3 The Impact of Pain
2.3.1 Demographic Impact
2.3.2 Financial Cost of Pain

3 Treating Pain: Drug Classes and Guidelines
3.1 NSAIDs
3.2 Opioids
3.2.1 Chronic Pain and Opioids
3.3 Antidepressants
3.4 Anticonvulsants

4 Post-Operative Pain Overview and Therapeutic Options
4.1 Impact of Post-Operative Pain
4.2 Pain Intensity in Surgical Sites
4.3 Site-specific Pain Relief
4.4 Postoperative Medications
4.4.1 Naropin
4.4.2 DepoDur, DepoMorphine and Propofol
4.4.3 Other Opioids for Pain Management
4.4.4 NSAIDs for Postoperative Pain

5 Back Pain Overview and Therapeutic Options
5.1 Sciatica
5.2 Facet Joint Problems
5.3 Osteoarthritis
5.4 Diseases and Back Pain
5.5 Low Back Pain
5.6 Pharmaceutical Relief for Back Pain
5.6.1 Transdermal Patches
5.6.2 Injections for Back Pain
5.6.3 Back Pain and Opioids
5.6.4 Tricyclic Antidepressants
5.6.5 Muscle Relaxers
5.6.6 Colchicine
5.6.7 Chronic Low Back Pain and Anticonvulsants

6 Neuropathic Pain Overview and Therapeutic Options
6.1 Nociceptive Versus Neuropathic Pain
6.2 Nociceptive and Neuropathic Mixed Pain
6.3 Neuropathic Pain
6.4 Neuropathic Pain Generation
6.5 Treating Neuropathic Pain
6.5.1 Transdermal Fentanyl
6.5.2 Ketamine and Alfentanil
6.5.3 Neurontin
6.5.4 Lyrica

7 Migraine Overview and Therapeutic Options
7.1 Impact of Migraines
7.2 Pharmacological Treatment of Migraine Pain
7.2.1 Fiorinal and Fioricet
7.2.2 Ergot Alkaloid Derivatives
7.2.3 Triptans
7.2.3.1 Comparing Triptans
7.2.3.2 Imitrex
7.2.3.3 Zomig
7.2.3.4 Maxalt
7.2.3.5 Relpax
7.2.4 Neuroleptics
7.2.5 Beta-blockers
7.3 New and Investigational Drugs for Migraine Pain
7.3.1 Topamax
7.3.2 Alexza
7.3.3 Botox
7.3.4 Trexima
7.4 Alternative Therapies for Migraine

8 Cancer Pain Overview and Therapeutic Options
8.1 Causes of Cancer Pain
8.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Cancer Pain
8.3 Opioids and Cancer Pain
8.3.1 Reluctance to Prescribe Opioids
8.4 Seizure Drugs for Cancer Pain
8.5 Investigational Drugs
8.5.1 Remoxy
8.5.2 Ziconatide
8.5.3 Chronogesic Pain Therapy System
8.5.4 Xen2174

9 Arthritic Pain Overview and Therapeutic Options
9.1 Impact of Arthritis
9.2 Rheumatoid Arthritis
9.2.1 Causes
9.2.2 RA Demographics
9.2.3 Genetic Susceptibility
9.2.4 Environmental Factors
9.2.5 High Cost of Rheumatoid Arthritis
9.3 Osteoarthritis
9.3.1 Causes
9.3.2 Pharmacological Treatment of Osteoarthritis
9.3.2.1 COX-2 Class
9.3.3 Pharmacological Treatment of Rheumatoid Arthritis
9.4 Antirheumatic Drug Classes
9.4.1 Nonsteroidal Anti-Inflammatory Drugs
9.4.2 Corticosteroids
9.4.3 Disease Modifying Anti-Rheumatic Drugs (DMARDs)
9.4.4 DMARD Competition
9.4.5 Slow-Acting Antirheumatic Drugs (SAARDs)
9.4.6 Biological Response Modifiers (BRMs)
9.4.7 Leading RA Medications
9.4.8 BRMs Versus DMARDs

10 Fibromyalgia Overview and Therapeutic Options
10.1 Manifestations
10.2 Impact of Fibromyalgia
10.3 Natural Treatments for Fibromyalgia
10.4 Prescription Treatments for Fibromyalgia
10.4.1 Treatment with Antidepressants
10.4.2 Muscle Relaxants
10.4.3 Sleep Modifiers
10.4.4 Anxiety Medications
10.4.5 Anticonvulsants
10.4.6 Antibiotics
10.5 Future Therapies for Fibromyalgia

11 Non-Pharmaceutical Pain Treatment
11.1 Acupuncture
11.1.1 Assessing Acupuncture?s Value
11.2 Osteopathic Manipulation
11.2.1 Osteopathic Treatment
11.2.2 Conditions Treated by Osteopaths
11.3 Physiotherapy
11.4 Reflexology
11.5 Neurostructural Integration Technique
11.6 Herbal medicine
11.7 Neurolytic Block Injections
11.7.1 Examples of Neurolytic Blocks
11.8 Chemical Neurolytic Blocks
11.9 Cryoablation
11.10 Radiofrequency Lesioning
11.11 Neurosurgical Procedures
11.12 Chemical Ablation
11.13 Nerve Blocks
11.14 Neurostimulation and Pain Control
11.15 Electro Thermal Disc Decompression/ Intradiscal Electro Thermocoagulation
11.16 Selective Nerve Root Injections
11.17 Facet Joint Pain Block
11.18 Trigger Spot Injections
11.19 Peripheral Nerve Injections
11.20 Cervical and Lumbar Epidural Blocks

12 NSAID Market Analysis
12.1 Overview
12.2 Over-the-Counter NSAIDs
12.2.1 Ibuprofen
12.2.2 Naproxen
12.2.3 Acetaminophen and Aspirin
12.3 Traditional Prescription NSAIDs
12.3.1 Diclofenac/Cataflam/Voltaren
12.3.2 Arthrotec
12.3.3 Mobic
12.3.3.1 Mobic?s Market Share
12.3.3.2 Mobic Vs Other NSAIDs
12.3.4 DayPro
12.3.4.1 Rheumatoid Arthritis Relief from DayPro
12.3.4.2 Osteoarthritis Relief from DayPro
12.3.5 Relafen
12.3.5.1 Relafen Versus Naproxen and Aspirin
12.3.5.2 Endoscopy Trials
12.4 The Future of the NSAID Market

13 Opioid Use and Market Trends
13.1 Drawbacks of Opioid Therapy
13.2 Treating Chronic Pain
13.3 Key Opioid Products
13.3.1 Morphine
13.3.1.1 Increased Usage of Morphine
13.3.1.2 Cognitive and Psychomotor Effects
13.3.1.3 Extended Release Morphine
13.3.2 Oxycodone
13.3.3 Kadian
13.3.3.1 Key Clinical Trial
13.3.4 Vicodin
13.3.5 Ultracet/Ultram
13.3.6 Duragesic
13.4 Legal Regulation of Opioids
13.5 Side Effects
13.6 Adjuvant Medications
13.7 Market Analysis
13.7.1 OxyContin
13.7.2 Duragesic
13.7.3 Kadian
13.7.4 Ultracet/Ultram
13.7.5 Avinza
13.7.6 Actiq
13.8 Key Opioid Products in Development
13.8.1 Chronogesic
13.8.2 Ionsys
13.8.3 Remoxy
13.9 The Future of the Opioid Market

14 Migraine Therapy Market
14.1 Overview
14.2 Leading Migraine Therapies
14.2.1 Imitrex/Imigran
14.2.2 Zomig
14.2.3 Relpax
14.2.4 Maxalt
14.3 Preventive vs. Abortive Therapy
14.4 The Future of the Migraine Market

15 Anticonvulsant Market
15.1 Overview
15.2 Leading Anticonvulsants
15.2.1 Neurontin
15.2.1.1 Generic Competition
15.2.2 Topamax
15.2.3 Depakote
15.2.4 Lamictal
15.2.5 Trileptal
15.2.6 Tegretol
15.3 The Future of the Anticonvulsant Market

16 Cox-II Inhibitors and the Future
16.1 The Fall of Bextra
16.1.1 Health Risks Alert
16.1.2 Thromboembolic Events
16.1.3 Post-marketing Reports for Bextra
16.1.4 Withdrawal of Bextra
16.2 The Fall of Vioxx
16.2.1 Public Health Advisory
16.2.2 Repercussions from the Vioxx Withdrawal
16.2.3 Fear of COX-2 Inhibitors
16.2.4 Financial Fallout for Merck
16.2.5 Vioxx vs Other Cox-2 Inhibitors
16.3 Celebrex: Surviving the Fallout
16.3.1 FDA Review of Clinical Trials
16.3.2 Black Box Warning
16.4 Future Scrutiny of Cox-2 Class
16.5 COX-2 Pipeline
16.5.1 Prexige
16.5.1.1 TARGET Assessment
16.5.2 Arcoxia
16.5.2.1 Future of Arcoxia
16.5.3 Dynastat
16.6 The Future of the Cox-II Class

17 Promising Areas of Research
17.1 Natural Painkillers
17.1.1 Peptides
17.1.2 Epibatidine
17.1.3 Chili Peppers and Capsaicin
17.1.4 Marijuana
17.1.5 Receptors as Gateways
17.1.6 Chromaffin Cells
17.1.7 Glutamate
17.1.8 Prialt
17.1.9 New Class of Analgesics

18 Company Briefs
Abbott Laboratories
AlgoRx Pharmaceuticals
Altea Therapeutics
Ardent Pharmaceuticals
AstraZeneca
Cephalon
Elan Pharmaceuticals
Endo Pharmacuticals
EpiCept
GlaxoSmithKline
Indevus Pharmaceuticals
Innovative Drug Delivery Systems
Johnson & Johnson
Metaphore Pharmaceuticals
Nastech Pharmaceutical
NeurogesX
Novartis Pharmaceuticals
Pain Therapeutics
Pfizer
Purdue
Renovis
SkyePharma