A crowded generics market makes gaining a strong foothold in the treatment of chronic pain challenging for branded agents. The treatment of chronic pain involves the use of drugs from several drug classes, including nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. However, opioid analgesics, a cornerstone of chronic pain treatment, are under intense scrutiny from the public, payers, and prescribers; such scrutiny provides further opportunities for developers of agents with less risk of abuse or deterrence, agents that are safer and more tolerable, and drugs with novel mechanisms of action (MOAs), such as biologics targeting nerve growth factor (NGF). The emergence of agents with novel MOAs and the increase in prevalence of key subpopulations (e.g., osteoarthritic (OA) pain, chronic low back pain) will, in part, drive market growth.

QUESTIONS ANSWERED:

  • How do interviewed experts perceive the chronic pain therapy market to be changing given the emphasis on the risk of abuse / misuse with opioid analgesics?
  • How influential are abuse-deterrent formulations of extended-release / long-acting opioid analgesics on U.S. physicians’ prescribing for severe chronic pain?
  • What will be the impact of new analgesics from various drug classes, most notably the first-in-class anti-NGF biologic therapies, given their reputed robust efficacy counterbalanced with safety risks, on the highly genericized chronic pain therapy market?
  • What are the greatest areas of unmet need in the treatment of chronic pain, and how are the emerging therapies expected to address these unmet needs?

PRODUCT DESCRIPTION

Disease Landscape & Forecast provides comprehensive market intelligence with world-class epidemiology, keen insight into current treatment paradigms, in-depth pipeline assessments, and drug forecasts supported by detailed primary and secondary research.

Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, and Japan.

Primary research: 41 country-specific interviews with thought-leading primary care physicians, pain specialists, neurologists, rheumatologists, and anesthesiologists. Supported by survey data collected for other DRG research.

Epidemiology: Prevalence, diagnosed, and drug-treated rates of chronic pain subpopulations by country, specifically cancer pain, chronic low back pain, fibromyalgia, and painful diabetic neuropathy; diagnosed prevalence of rheumatoid arthritis pain, OA pain, and postherpetic neuralgia, by country.

Forecast: Five- and ten-year drug-level sales of key chronic pain therapies through 2028; forecast base-year segmentation by select chronic pain populations.

Emerging Therapies: Phase II: 21 drugs; Phase III / preregistration / registration: 12 drugs.

Table of contents

  • Chronic Pain - Landscape & Forecast - Disease Landscape & Forecast
    • Key Updates
      • Q2 2021
        • June 2021
        • May 2021
        • April 2021
      • Q1 2021
        • Q2 2020
          • Q4 2019
          • Key Findings
            • Chronic Pain — Key Findings — February 2021
            • Market Outlook
              • Key Findings
                • Market Share of Chronic Pain by Indication: 2018
                • Market Share of Drug Classes for Chronic Pain: 2018
                • Market Share of Drug Classes for Chronic Pain: 2028
                • Chronic Pain SWOT Analysis
              • Market Drivers and Constraints
                • What Factors Are Driving the Market for Chronic Pain?
                • What Factors Are Constraining the Market for Chronic Pain?
                • Regional Chronic Pain Drug Market: 2018-2028
              • COVID-19: Forecast Impact
                • Drug-Class-Specific Trends
                  • Antidepressants
                  • Market Share of Antidepressants for Chronic Pain: 2018-2028
                  • Antiepileptic Drugs
                  • Market Share of Antiepileptic Drugs in Chronic Pain: 2016-2026
                  • Subtype-Selective Sodium Channel Antagonists
                  • NSAIDs
                  • Market Share of NSAIDs for Chronic Pain: 2018-2028
                  • COX-2-Selective NSAIDs
                  • Market Share of COX-2-Selective NSAIDs for Chronic Pain: 2018-2028
                  • Opioid Analgesics
                  • Market Share of Opioid Analgesics in Chronic Pain: 2018-2028
                  • Dual-Acting Opioid Analgesics
                  • Market Share of Dual-Acting Opioid Analgesics in Chronic Pain: 2018-2028
                  • Opioid Combinations (NSAIDs / Acetaminophen)
                  • Local Anesthetics
                  • TRPV1 Agonists
                  • Market Share of TRPV1 Agonists in Chronic Pain: 2018-2028
                  • Anti-NGF Therapies
                  • Market Share of Anti-Nerve Growth Factor Therapies in Chronic Pain: 2028
                  • Cytokine Inhibitors
                  • Market Share of Cytokine Inhibitors in Chronic Pain: 2018-2028
                  • Viscosupplements
                  • Market Share of Viscosupplements in Chronic Pain: 2018-2028
                  • Wnt Pathway Inhibitors
                  • Market Share of Wnt Pathway Inhibitors in Chronic Pain: 2018-2028
              • Forecast
                • Sales of Drugs to Treat Chronic Pain in the Major Pharmaceutical Markets by Indication: 2018
                • Sales of Drugs to Treat Chronic Pain in the Major Pharmaceutical Markets: 2018, 2023, and 2028
              • Etiology and Pathophysiology
                • Disease Overview
                  • Etiology
                    • Conditions Causing Chronic Pain
                    • Chronic Pain Indications and Their Potential Pathophysiological Components
                  • Pathophysiology
                    • Nociceptive Pain
                    • Pathophysiological Components of Nociceptive, Inflammatory, and Neuropathic Pain
                    • Inflammatory Pain
                    • Neuropathic Pain
                  • Key Pathways and Drug Targets
                    • Ascending and Descending Pain Pathways
                    • Drug Targets in Chronic Pain
                    • Detailed Schematic of Nociceptive and Antinociceptive Pathways in the Dorsal Horn of the Spinal Cord
                • Epidemiology
                  • Introduction
                    • Key Findings
                  • Epidemiology Populations
                    • Disease Definition
                    • Methods
                    • Sources Used for Diagnosed Prevalent Cases of Rheumatoid Arthritic Pain
                    • Number of Diagnosed Prevalent Cases of Rheumatoid Arthritic Pain in the Major Pharmaceutical Markets: 2018-2028 (thousands)
                    • Disease Definition
                    • Methods
                    • Sources Used for Diagnosed Prevalent Cases of Osteoarthritic Pain
                    • Number of Diagnosed Prevalent Cases of Osteoarthritic Pain in the Major Pharmaceutical Markets: 2018-2028 (thousands)
                    • Disease Definition
                    • Methods
                    • Sources Used for Total Prevalent Cases of Cancer Pain
                    • Number of Total Prevalent Cases of Cancer Pain in the Major Pharmaceutical Markets by Subtype: 2018-2028 (thousands)
                    • Disease Definition
                    • Methods
                    • Sources Used for Total Prevalent Cases of Chronic Low Back Pain
                    • Number of Total Prevalent Cases of Chronic Low Back Pain in the Major Pharmaceutical Markets 2018-2028 (thousands)
                    • Disease Definition
                    • Methods
                    • Sources Used for Total Prevalent Cases of Fibromyalgia
                    • Number of Total Prevalent Cases of Fibromyalgia in the Major Pharmaceutical Markets: 2018-2028 (thousands)
                    • Disease Definition
                    • Sources Used for Total Prevalent Cases of Painful Diabetic Neuropathy
                    • Number of Total Prevalent Cases of Painful Diabetic Neuropathy in the Major Pharmaceutical Markets: 2018-2028 (thousands)
                    • Disease Definition
                    • Methods
                    • Sources Used for Diagnosed Prevalent Cases of Postherpetic Neuralgia
                    • Number of Diagnosed Prevalent Cases of Postherpetic Neuralgia in the Major Pharmaceutical Markets: 2018-2028 (thousands)
                    • Trigeminal Neuralgia
                    • Complex Regional Pain Syndrome
                    • Percentage Diagnosed
                    • Percentage Drug-Treated
                    • Percentage of Diagnosed and Drug-Treated Patients in Key Chronic Pain Populations: 2018-2028
                • Current Treatment
                  • Key Findings
                    • Treatment Goals
                      • Key Endpoints Used in Clinical Trials for Chronic Pain
                    • Key Current Therapies
                      • Overview
                      • Mechanism of Action of Key Current Drug Classes Used for Chronic Pain
                      • Current Treatments Used for Chronic Pain
                      • Market Events Impacting the Use of Key Current Therapies for Chronic Pain
                      • Advantages and Disadvantages of Select Antidepressants
                      • Expert Insight: Antidepressants
                      • Advantages and Disadvantages of Select Antiepileptic Drugs
                      • Expert Insight: Antiepileptic Drugs
                      • Advantages and Disadvantages of NSAIDs
                      • Expert Insight: NSAIDs
                      • Advantages and Disadvantages of COX-2-Selective NSAIDs
                      • Expert Insight: COX-2-Selective NSAIDs
                      • Transdermal Opioid Formulations
                      • Advantages and Disadvantages of Opioid Analgesics
                      • Expert Insight: Opioid Analgesics
                      • REMS for LA / ER Opioids
                      • Postmarketing Study Requirements for LA / ER Opioids
                      • Advantages and Disadvantages of Select Dual-Acting Opioid Analgesics
                      • Expert Insight: Dual-Acting Opioid Analgesics
                      • Advantages and Disadvantages of Opioid / NSAID or Acetaminophen Analgesics
                      • Expert Insight: Opioid / NSAID or Acetaminophen Combinations
                      • Advantages and Disadvantages of Select TRPV1 Agonists
                      • Expert Insight: TRPV1 Agonists
                      • Advantages and Disadvantages of Select Local Anesthetics
                      • Expert Insight: Local Anesthetics
                      • Advantages and Disadvantages of Cytokine Inhibitors
                      • Expert Insight: Cytokine Inhibitors
                      • Advantages and Disadvantages of Viscosupplements
                      • Expert Insight: Viscosupplements
                    • Medical Practice
                      • Overview
                      • Country-Specific Chronic Pain Treatment Guidelines
                      • Factors Influencing Drug Selection in Chronic Pain
                      • Drug Selection in Chronic Pain in the United States
                      • Drug Selection in Chronic Pain in Europe
                      • Drug Selection in Chronic Pain in Japan
                  • Unmet Need Overview
                    • Current and Future Attainment of Unmet Needs in Chronic Pain
                    • Top Unmet Needs in Chronic Pain: Current and Future Attainment
                    • Expert Insight: Unmet Need in Chronic Pain
                  • Emerging Therapies
                    • Key Findings
                      • Pipeline Trends in Chronic Pain
                    • Key Emerging Therapies
                      • Therapies in Late-Phase Development for Chronic Pain
                      • Estimated Launch Dates of Key Emerging Therapies for the Treatment of Chronic Pain
                      • BIIB074 Profile
                      • Analysis of the Clinical Development Program for BIIB074
                      • Clinical Development Milestones for BIIB074 in the Treatment of Chronic Pain
                      • Expert Insight: BIIB074
                      • Expectations for Launch and Sales Opportunity of BIIB074 in Chronic Pain
                      • Likely Uses of BIIB074 in the Treatment of Chronic Neuropathic Pain
                      • NSAID and COX-2-Selective NSAID Reformulations Profile
                      • Expert Insight: NSAIDs and COX-2 Selective NSAIDs
                      • Expectations for Launch and Sales Opportunity of NSAID and COX-2-Selective NSAID Reformulations in Chronic Pain
                      • CAM2038 Profile
                      • Analysis of the Clinical Development Program for CAM2038
                      • Clinical Development Milestones for CAM2038 in the Treatment of Chronic Pain
                      • Expert Insight: CAM2038
                      • Expectations for Launch and Sales Opportunity of CAM-2038 in Chronic Pain
                      • Likely Uses of CAM2038 in the Treatment of Chronic Pain
                      • Cebranopadol Profile
                      • Analysis of the Clinical Development Program for Cebranopadol
                      • Clinical Development Milestones for Cebranopadol in the Treatment of Chronic Pain
                      • Expert Insight: Cebranopadol
                      • Expectations for Launch and Sales Opportunity of Cebranopadol in Chronic Pain
                      • Likely Uses of Cebranopadol in the Treatment of Chronic Pain
                      • Oxycodone XR (Abuse-Deterrent, Intellipharmaceutics) Profile
                      • Analysis of the Clinical Development Program for Oxycodone XR (Abuse-Deterrent, Intellipharmaceutics)
                      • Clinical Development Milestones for Oxycodone XR (Abuse-Deterrent, Intellipharmaceutics) in the Treatment of Chronic Pain
                      • Expert Insight: Oxycodone XR (Abuse-Deterrent, Intellipharmaceutics)
                      • Expectations for Launch and Sales Opportunity of Oxycodone XR (Abuse-Deterrent, Intellipharmaceutics) in Chronic Pain
                      • Fasinumab Profile
                      • Analysis of the Clinical Development Program for Fasinumab
                      • Key Development Milestones for Fasinumab in the Treatment of Chronic Pain
                      • Expectations for Launch and Sales Opportunity of Fasinumab in Chronic Pain
                      • Key Results from Select Pivotal Clinical Trials Investigating Tanezumab for the Treatment of Chronic Pain
                      • Analysis of the Clinical Development Program for Tanezumab
                      • Key Development Milestones for Tanezumab in the Treatment of Chronic Pain
                      • Expectations for Launch and Sales Opportunity of Tanezumab in Chronic Pain
                      • Expert Insight: Anti-NGF Therapies
                      • Likely Uses of Anti-NGF Therapies for the Treatment of Chronic Pain
                      • Ampion (DMI-9523) Profile
                      • Analysis of the Clinical Development Program for Ampion (DMI-9523)
                      • Clinical Development Milestones for Ampion in the Treatment of Chronic Pain
                      • Expert Insight: Use of Ampion (DMI-9523) in the Treatment of Chronic Pain
                      • Expectations for Launch and Sales Opportunity of Ampion (DMI-9523) in Chronic Pain
                      • Likely Uses of Ampion for the Treatment of Chronic Pain
                      • VM202 (Donaperminogene Seltoplasmid) Profile
                      • Analysis of the Clinical Development Program for VM202
                      • Clinical Development Milestones for VM202 in the Treatment of Chronic Pain
                      • Expert Insight: VM202
                      • Expectations for Launch and Sales Opportunity of VM202 in Chronic Pain
                      • Lorecivivint Profile
                      • Analysis of the Clinical Development Program for Lorecivivint
                      • Clinical Development Milestones for Lorecivivint in the Treatment of Chronic Pain
                      • Expert Insight: Lorecivivint
                      • Expectations for Launch and Sales Opportunity of Lorecivivint in Osteoarthritic Pain
                      • Likely Uses of Lorecivivint in the Treatment of Chronic Pain
                      • CNTX-4975 Profile
                      • Analysis of the Clinical Development Program for CNTX-4975
                      • Clinical Development Milestones for CNTX-4975 in the Treatment of Chronic Pain
                      • Expert Insight: CNTX-4975
                      • Expectations for Launch and Sales Opportunity of CNTX-4975 in Osteoarthritic Pain
                      • Likely Uses of CNTX-4975 in the Treatment of Chronic Pain
                    • Early-Phase Pipeline Analysis
                      • Select Therapies in Phase II Development for Chronic Pain
                    • Key Discontinuations and Failures in Chronic Pain
                    • Access & Reimbursement Overview
                      • Region-Specific Reimbursement Practices
                        • Key Market Access Considerations in Chronic Pain: United States
                        • General Reimbursement Environment: United States
                        • Key Market Access Considerations in Chronic Pain: EU5
                        • General Reimbursement Environment: EU5
                        • Key Market Access Considerations in Chronic Pain: Japan
                        • General Reimbursement Environment: Japan
                    • Appendix
                      • Key Abbreviations Related to Chronic Pain
                      • Brands, Marketers, and Generic Availability of Current Therapies Used for Chronic Pain by Market
                      • Chronic Pain Bibliography

                  Author(s): Joyce Spadafora, A.L.M.; Arava Suresh, M.Pharm.; Natalie Taylor, Ph.D.

                  Joyce Spadafora, A.L.M., is a senior analyst on the CNS/Ophthalmology Disorders team. She authors content on various chronic pain, psychiatric, and neurological indications. Prior to joining the company, she spent several years in the biotech industry focusing on new product development and consulting. She holds a master’s degree in extension studies in psychology from Harvard University and a bachelor's of science in mechanical engineering with biology from the Massachusetts Institute of Technology.

                  Suresh Arava, M.Pharm., is a research associate on the CNS/Ophthalmology Disorders team at Clarivate. He earned a master’s degree in pharmaceutical administration and management from Manipal University in India.

                  Natalie Taylor, Ph.D., is a principal business insights analyst on the CNS/Ophthalmology Disorders team at Clarivate. She has more than ten years of experience authoring primary and market research reports for pharmaceutical industry clients in the fields of psychiatry, pain, neurology, and ophthalmology. Previously, Dr. Taylor worked at QuintilesIMS as manager of its CNS portfolio. She completed her Ph.D. in physiology at Dartmouth College in New Hampshire, where she studied the role of serotonergic neurons in the medullary raphe on modulating respiratory responses in mammals. She holds a B.S. in biology from Dickinson College in Pennsylvania.


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