NEW YORK, Feb. 1, 2012  /PRNewswire/ -- Reportlinker.com announces that a new market research report is available in its catalogue:

Pain Therapeutics - Drugs, Markets and Companies

http://www.reportlinker.com/p0203548/Pain-Therapeutics---Drugs-Markets-and-Companies.html#utm_source=prnewswire&utm_medium=pr&utm_campaign=Drug_and_Medication

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 2011 and projected to 2021. 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 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

TRP ion channels in pain 45

Genetic basis of pain 45

Study of genes in pain 46

Pain as a channelopathy 47

Pain in the brain 47

Neuropathic pain-induced morphological changes in the brain 48

Change from acute to chronic pain 48

Descending facilitatory modulation of pain 48

Development of chronic pain following severe accidental injury 49

Pain and transcriptional repressor DREAM 49

Role of neuronal plasticity in pain 49

Neurochemistry of pain 50

Molecular elements of pain in the peripheral nervous system 50

Molecular elements of pain in the central nervous system 51

Opioid receptors 51

Role of AMPA receptors in chronic pain 52

Kinins 52

Serotonin 52

Substance P 53

Excitatory amino acids 53

Role of nitric oxide in pain 53

Prostaglandins 54

Endocannabinoids 55

Protein kinase C 55

Adenosine and adenosine receptors 55

Vitamin D and pain 55

Vanilloid receptor 56

TRPA1 and TRPV1 receptors 56

Endothelin-B receptors 57

Nerve growth factor and pain 57

Adrenomedullin as a pain-related peptide 58

Biomarkers of pain 58

Biomarkers of visceral pain 58

2. Assessment of Pain and Analgesics 61

Introduction 61

Animal models of pain 61

An overview 61

Selection of animal species as models for pain 61

Types of noxious stimuli 62

Animal models of neuropathic pain 62

Animal models of arthritis 62

Animal models of peripheral neuropathy 63

Limitations of current pain models 63

Biogenic animal model of chronic pain 64

Ethical issues concerning animal pain models 64

Medical evaluation of pain 65

Chronic pain as a manifestation of various diseases 65

Assessment of pain patients 65

Medical examination 65

Measurement of pain 66

Quantitative sensory testing 67

Pain measurement tools for neonates and children 68

Quantitative sensory testing 68

Psychological assessment of pain 69

Brain imaging in pain 69

PET for study of pain 69

PET correlated with fMRI and evoked potentials 70

Patient outcomes and quality of life during treatment for chronic pain 70

Collection and analysis of data on pain patients 71

Evaluation of analgesics in humans 71

Early phase clinical trials of analgesics in humans 71

Design of clinical trials for pain 72

Assessment of neuropathic pain 73

Transdermal electrical stimulation for study of chronic pain 73

Placebo effect in pain 74

Role of electronic pain recording in determination of the placebo effect 74

Outcome measures for chronic pain trials 75

Pain, pain therapies and cognitive function 75

3. Pharmacotherapy of Pain 77

Introduction 77

Mechanism of action of currently used pain medications 77

Non-steroidal antiinflammatory drugs 78

COX-2 inhibitors 78

Celecoxib 79

Metamizole 80

Nimesulide 80

Rofecoxib 80

Valdecoxib 81

Lumiracoxib 81

Side effects of COX inhibitors 82

Innovative COX-2 inhibitors in development 83

Acetaminophen 84

Antioxidants as analgesics 84

Opiates and opioids 85

Innovations in opioid therapy 85

Oral transmucosal fentanyl 86

Use of opioids for chronic non-cancer pain 86

Opioid receptor modulation for visceral pain 86

Opiorphin 87

N-methyl-D-aspartate receptor antagonists 87

Ketamine 87

CNS 5161 88

Triptans for treatment of non-migrainous pain 88

Capsaicin 88

NGX-4010 89

Local anesthetics 89

Topical application 89

Nerve blocks 89

Injection of local anesthetics for analgesia 90

Ultrasound-guided nerve blocks 90

Topical salicylates for the treatment of pain 90

Topical rubefacients for acute and chronic pain in adults 90

Adjunctive analgesics 91

Antidepressants 91

Mechanism of analgesic action of antidepressants 92

Antiepileptic drugs 93

Mechanism of action of antiepileptic drugs in neuropathic pain 93

Carbamazepine 94

Gabapentin 94

Lamotrigine 95

Phenytoin 95

Pregabalin 96

Topiramate 97

Valproic acid 97

Other antiepileptic drugs 97

Clonidine 97

Baclofen 98

Corticosteroids 98

Calcitonin 99

Bisphosphonates 99

Botulinum toxins 99

Analgesic effect of botulinum toxin A 100

Engineered botulinum toxin 100

Analgesics from traditional medical systems 100

Herbs and other plants 101

Analgesics derived from cobra toxin 102

Adverse effects of analgesics 102

Gastrointestinal adverse effects of NSAIDs 102

Measures to reduce gastrointestinal adverse effects of NSAIDs 102

Cardiovascular adverse effects of COX-2 inhibitors 102

Adverse effects of opioids 103

Risk of addiction and development of tolerance 103

Companies developing products to deter abuse of opioids 103

Remoxy versus Oxycontin 104

Hyperalgesia associated with opioids 104

Respiratory depression 105

Opioid-associated constipation 105

Narcotic bowel syndrome 105

Adverse effects of use of opioids in non-malignant pain 105

Approaches to reduce adverse effects of opioids 106

PEGylated naloxol 106

Innovative approaches to modify opioid pharmacology 106

Regulatory aspects of opioid abuse, overdose and death 106

Adverse effects of miscellaneous non-narcotic analgesics 107

Adverse effects of immunosuppressants used for relief of pain 107

Adverse effects of acetaminophen 108

4. Management of Pain 109

Introduction 109

Sites for pain management 109

Self-medication at home 109

Physicians' offices 109

Major hospitals 109

Pain centers 110

Non-pharmacological approaches to pain 110

Alternative medicine 110

Acupuncture 111

Aromatherapy 111

Self-Controlled Energo Neuro Adaptive Regulation 112

Behavioral therapy 112

Cognition and pain 112

Control over brain activation and pain by using functional MRI 112

Thermal-grill illusion 113

Virtual reality therapy 113

Local application of heat 113

Transcutaneous nerve stimulation 114

Transcranial magnetic stimulation 114

Neurosurgery for pain relief 114

Ablative procedures on the nervous system 115

Procedures on peripheral, spinal and cranial nerves 115

Vagal nerve stimulation for control of pain 115

Neuromodulation 115

Spinal cord stimulation 116

Brain stimulation 117

Implantation of drug delivery devices 117

Management of special types of pain 117

Acute pain 117

Management of acute renal colic: NSAIDS vs. opioids 117

Combination of opioids and NSAIDs for acute pain 118

Reasons for inadequate management of acute pain 118

Perioperative pain management 118

Devices for delivery of analgesics in the postoperative period 119

Drug combination for perioperative pain 120

Gabapentin for reduction of postoperative pain 120

Ketamine for perioperative pain 120

Opioids for perioperative pain 121

Perioperative pain in neurosurgery 121

Prolonged duration local anesthesia 121

Concluding remarks on the management of postoperative pain 122

Pain in the intensive care unit 122

Pain associated with sports and exercise 123

Pain associated with trauma 123

Chronic abdominal pain 124

Functional somatic syndromes 124

Fibromyalgia syndrome 124

Pathomechanism of FMS 125

Management of FMS 125

New developments in pharmacotherapy of FMS 126

Erythromelalgia 127

Irritable bowel syndrome 127

Opioids for IBS 128

Tricyclic antidepressants for IBS 128

Serotonin-modulating drugs for IBS 129

Musculoskeletal pain 129

Myofascial pain syndrome 129

Osteoarthritis 130

Pathomechanism of osteoarthritis 130

Pain aggravates osteoarthritis by crosstalk between CNS and the joint 131

Management of osteoarthritis 131

Rheumatoid arthritis 132

Management of pain in rheumatoid arthritis 133

Disease modifying therapies in rheumatoid arthritis 133

Resurgence of interest in gold-based treatments for RA 134

Backache 134

Use of analgesics for management of back pain 135

Miscellaneous medical therapies for backache and sciatica 136

Neck pain 136

Chronic pelvic pain 137

Prostatitis 137

Cancer pain 137

Opioid treatment of cancer pain 138

Breakthrough and opioid-insensitive pains 139

Morphine-induced enhancement of cancer growth and its prevention 139

Methods of delivery of opioids for cancer pain 140

Implantation of drug delivery devices 140

Management of bone pain in cancer 141

Use of non-opioid analgesics for cancer pain 141

Adjuvant drugs for cancer pain 142

Radiation therapy 142

Alternative non-pharmacological methods 142

Anesthetic techniques 142

Surgical methods of cancer pain relief 142

Conclusions regarding management of cancer pain 143

Chronic non-malignant pain 143

Headache 144

Migraine 144

Management of acute migraine 145

Neurostimulation for migraine 149

Transcranial magnetic stimulation for migraine 150

Migraine prophylaxis 150

Cluster headache 151

Paroxysmal hemicrania 151

Tension headache 151

Chronic daily headache 152

Trigeminal neuralgia 152

Dental pain 153

Neuropathic pain 153

Pathogenesis of neuropathic pain 153

Chronobiology of neuropathic pain as guide to therapy 154

Management of neuropathic pain based on mechanism 155

Guidelines for the management of neuropathic pain 155

Pharmacotherapy of neuropathic pain 155

Evidence-based management of neuropathic pain 158

Management of central neuropathic pain 158

Neurosurgical approaches to central neuropathic pain 158

Management of neuropathic pain in syringomyelia 159

Neuropathic pain associated with spinal cord injury 159

Peripheral neuropathic pain 160

Management of postsurgical peripheral neuropathic pain 160

Management of chemotherapy-induced pain 160

Morton's neuroma 161

Management of peripheral diabetic neuropathy 161

Postherpetic neuralgia 163

Complex regional pain syndrome 165

An algorithm for the management of peripheral neuropathic pain 166

Phantom limb pain 167

Pathomechanism of phantom limb pain 167

Management of phantom limb pain 167

Pain and depression 169

Neurochemical link between pain and depression 170

Management of chronic pain and depression 170

Miscellaneous painful conditions 171

Burning mouth syndrome 171

Chronic unstable angina 172

Mastalgia 172

Ophthalmic pain 172

Pain in Parkinson's disease 173

Management of chronic unexplained pain 173

Management of itching 173

Topical applications for itching 174

Systemic therapies for itching 175

Non-pharmacological therapies for itch 176

Management of pain in special population groups 176

Racial and ethnic differences in pain management 176

Pain in neonates 176

Management of pain in children 177

Management of pain in the elderly 177

Management of pain in women 179

Reasons for increased pain perception in women 179

Chronic pelvic pain in women 179

Gender differences in response to analgesics 179

Considerations for pain management in women 180

Management of pain in neurologically handicapped persons 180

Management of pain in the cognitively impaired elderly people 181

Management of pain in brain-damaged minimally conscious patients 181

Management of pain in the terminally ill 182

Deficiencies in the management of pain 182

Negative physician attitudes in pain management 183

Suggestions for improvement of pain management by healthcare providers 183

Pain as the fifth vital sign 184

Management of neuropathic pain in patients refractory to first line treatment 184

Multidisciplinary approaches to pain management 184

5. Drug Delivery for Pain 187

Introduction 187

Intra-articular injection for relief of joint pain 188

Controlled release drug delivery for pain 188

Accelerating the effect of subcutaneous morphine 188

Controlled drug delivery at site of pain 188

Oral extended release opioids 189

Extended release oral morphine 189

Controlled release oxycodone 190

Extended release oxymorphone 190

Oral extended release tramadol 190

Extended release gabapentin 191

Use of nanotechnology for drug delivery for pain 191

Non-injection methods of delivery of analgesics 191

Topical applications for pain 192

Topical local anesthetics 192

Topical NSAIDs 192

Topical and transdermal diclofenac 193

Topical application for postoperative pain 193

Needle-free drug delivery for pain 194

Glide SDI® solid dose injector 194

SUMAVEL™ DosePro™ needle-less injection 194

Transdermal drug delivery for pain 194

Relief of pain associated with minor medical procedures 194

Transdermal fentanyl 195

Transdermal ketoprofen 196

Transdermal nitroglycerine as an adjuvant to opioids 197

Transdermal buprenorphine 197

Transdermal trans-capsaicin 197

Powder Injection Systems 198

Intranasal delivery of analgesics 198

Intranasal morphine 199

Intranasal morphine derivatives 199

Intranasal fentanyl 200

Intranasal buprenorphine 200

Intranasal ketamine 200

Intranasal ketorolac 201

Nasal formulations for migraine 201

Oral spray formulations for migraine 201

Delivery of analgesics by inhalation 202

Buccal transmucosal and sublingual delivery of analgesics 203

Application for cancer pain 203

Application for non-cancer pain 203

Pumps for drug delivery in pain 204

Patient controlled analgesia 204

Postoperative pain pumps 204

Chronogesic (sufentanil) Pain Therapy System 205

Spinal pumps for delivery of analgesics 206

Spinal delivery of analgesics 206

Epidural administration of analgesics 207

Epidural dexamethasone 207

Epidural etanercept 208

Epidural morphine 208

Intrathecal administration of analgesics 208

Intrathecal CGX1160 208

Intrathecal fadolmidine 208

Intrathecal lidocaine 209

Intrathecal neostigmine 209

Intrathecal non-NMDA antagonists 209

Intrathecal prostaglandin antagonists 209

Intrathecal resiniferatoxin 210

Intrathecal ziconotide 210

Concluding remarks on intrathecal delivery of analgesic agents 211

Intracerebroventricular morphine for pain 211

Development of drug delivery systems for pain therapy 211

Delivery of analgesics to the CNS across the blood brain barrier 212

Drug delivery systems in clinical trials 212

6. Drug Development for Pain 215

Introduction 215

Drugs in development for pain 215

Current research goals 216

The ideal analgesic 216

Pain R & D goals in the pharmaceutical industry 216

Drug targets in the spinal cord 217

Drug targets in the brain 217

Molecular targets for analgesic drugs 217

Activation of P2X7 receptors 217

Adenosine receptor agonists 218

Alfa2-adrenergic receptor agonists 218

Anti-NGF strategies 218

Bradykinin antagonists 219

Cannabinoids 219

Cannabinoid receptor agonists 220

Cannabidiol 221

Cannabinor 222

Nabilone 222

Capsaicin and VR1 receptor-based analgesics 223

Vanilloid (capsaicin) receptor antagonists 223

VR1 receptor agonists 223

CCR2 receptor blockade 224

Cholecystokinin antagonists 224

Cholinergic receptor agonists 224

Conotoxins as analgesics 225

Corticotropin-releasing factor 226

FAAH inhibitors 226

PF-3845 227

URB597 227

Free radical scavengers as analgesics 227

Superoxide dismutase mimetics 228

GABA analogues 228

Subtype-selective GABAergic drugs 228

Glial cell line-derived neurotrophic factor 229

Glutamate receptor antagonists 229

NMDA receptor modulation for neuropathic pain 229

Alternatives to direct blocking of NMDA receptors 230

Glycine antagonists 230

Metabotropic glutamate receptors 230

Histogranin-like compounds for the management of pain 231

Ion channels as targets for analgesic drugs 231

Acid-sensing ion channels as drug target 231

Calcium channel blockers 232

P2X ion channel receptor antagonists 232

Sodium channel modulation 233

Mas-related GPCR agonists 233

Microsomal prostaglandin E synthase inhibitors 234

NAALADase inhibitors 235

Nerve growth factor antagonists 235

Newer COX inhibitors 235

COX-3 inhibitors 236

Dual cyclooxygenase/lipoxygenase inhibitors 236

Neuropeptide receptor antagonists for improving the efficacy of opioids 236

Nicotinic acetylcholine receptors 236

Mode of action of nACh/neural nicotinic receptor agonists 237

Potential of central nACh/neural nicotinic receptor agonists 237

Nitric oxide-based analgesics 238

Nitric oxide-releasing NSAIDs 238

Pharmacology of NO-SAIDs 239

COX-inhibiting nitric oxide donors 239

NO-donating structures to extend life cycle of existing analgesics 240

Nitric oxide mimetics 240

Neuronal nitric oxide synthase inhibitors 240

Norepinephrine transporter inhibition 240

Opioid peptide receptors ligands 241

Opioids with unique receptor characteristics 242

Buprenorphine 242

Nociceptin 242

Tapentadol 243

Opioid analgesics acting outside the CNS 243

Opioid analgesics acting at peripheral receptors 243

Peripherally acting mu-opioid receptor agonists 244

Targeting of opioid peptide-containing immune cells 244

Advantages of peripherally selective opioid drugs 244

Resolvins 245

Somatostatin analogs 245

Substance P and neurokinin receptor antagonists 245

Substance P-Saporin 246

Targeting prostanoid synthesis 246

Tetrodotoxin based analgesics 247

TRPV1 antagonists 247

TRPV1 antagonists in clinical trials 248

TRPV1-mediated entry of sodium channel blocker QX-314 249

Tumor necrosis factor-? antagonists 249

Cell and gene therapies for pain 250

Cell therapy 250

Implantation of chromaffin cells 250

Role of stem cells in management of pain 251

Implantation of astrocytes secreting enkephalin 251

Cells for delivery of antinociceptive molecules 251

Implantation of genetically engineered cells 252

Cell therapy for low back pain 252

Cell therapy for knee pain due to degenerative disorders 253

Cell therapy for peripheral neuropathic pain 253

Concluding remarks on cell therapy for pain 253

Gene therapy 254

Rationale of gene therapy for pain 254

Vectors for gene therapy of pain 255

Methods of gene delivery for pain 255

Vectors for endogenous analgesic production in cranial neuralgias 256

Gene delivery by intrathecal route 256

Gene transfer to the dorsal nerve roots 257

Gene therapy of peripheral neuropathy 258

Gene transfer by injections into the brain substance 258

Zinc finger DNA-binding protein therapeutic for chronic pain 259

Gene therapy for producing enkephalin to block pain signals 259

Targeting nuclear factor-?B 260

Gene therapy targeted to neuroimmune component of chronic pain 260

Antisense therapy for pain 260

RNAi-based approaches for pain therapy 261

Potential applications of gene therapy for management of pain 262

Concluding remarks about gene therapy for pain 262

Preclinical development of pain drugs 263

NGF-blocking antibody 264

Prostatic acid phosphatase as a novel analgesic 264

Preclinical development of drugs for neuropathic pain 264

5-HT receptor agonists 265

A-803467 266

AM1241 266

Artemin/Neuroblastin 266

Capsazepine 267

Central nACh receptor agonists 267

CGP 35024 267

Drugs that suppress glial activation 268

Erythropoietin 268

Gene therapy for neuropathic pain 268

NCX 8001 269

NR2B subtype NMDA receptor ligands 269

NW-1029 270

R116301 270

Targeting tumor necrosis factor 270

Future targets for osteoarthritic pain 270

Pain drugs in clinical trials 271

Clinical trials of miscellaneous drugs for pain 271

Alvimopan 273

Asimadoline 273

EN3202 274

Oxytrex 274

Drugs in clinical trials for postsurgical pain 274

Bicifadine 275

DepoMorphine 276

Cox-2 inhibitors in clinical trials 276

Clinical trials of disease modifying therapies for arthritis

To order this report:Drug and Medication Industry: Pain Therapeutics - Drugs, Markets and Companies

More  Market Research Report

Check our  Industry Analysis and Insights

 

Nicolas Bombourg
Reportlinker
Email: nbo@reportlinker.com
US: (805)652-2626
Intl: +1 805-652-2626

 

SOURCE Reportlinker

Back to top

RELATED LINKS
http://www.reportlinker.com