Executive Summary 12
Overview and epidemiology of pain 12
Global market analysis 13
Pipeline analysis 14
Competitive landscape 15

Chapter 1 Scope and methodology 18
Scope 18
Methodology 18

Chapter 2 Overview and epidemiology of pain 22
Summary 22
Introduction 23
Neuropathic pain 26
Lower back pain 26
Background 26
Diagnosis, treatment and management 27
Epidemiology 29
Neuralgia/fibromyalgia 31
Background 31
Diagnosis, treatment and management 32
Epidemiology 32
Diabetic neuropathic pain 35
Background 35
Diagnosis, treatment and management 35
Epidemiology 37
Pain associated with multiple sclerosis 39
Background 39
Diagnosis, treatment and management 40
Epidemiology 41
Nociceptive pain 43
Arthritic pain 43
Background 43
Diagnosis, treatment and management 44
Epidemiology 45
Post-operative pain 49
Background 49
Diagnosis, treatment and management 49
Epidemiology 50
Cancer-related pain 52
Background 52
Diagnosis, treatment and management 52
Epidemiology 53
HIV/AIDS-related pain 57
Background 57
Diagnosis, treatment and management 57
Epidemiology 58

Chapter 3 Global market analysis 62
Summary 62
Introduction 63
Key events 63
Revival of Mundipharma’s OxyContin CR sales followin out-ofcourt settlements 63
Mylan’s fentanyl patches may succeed where J&J’s Duragesic failed 64
OGD loosens requirements for generic lidocaine patches 65
M&A and licensing deals to drive the global pain management market 65
Regional dynamics 67
Market analysis by drug class 68
Leading brands in the global pain market 69
Analgesics 71
Analgesics market analysis by drug class 72
Leading brands in the analgesics market 73
Leading players in the analgesics market 75
Analgesic drug classes 76
Narcotic analgesics 76
Non-narcotic analgesics 86
Analgesics sales forecasts 91
Anticonvulsants 91
Leading brands in the anticonvulsants market 93
Leading players in the anticonvulsants market 105
Anticonvulsants sales forecasts 106
Non-steroidal anti-inflammatory drugs 107
NSAIDs market analysis by drug class 108
Leading brands in the NSAIDs market 109
Leading players in the NSAIDs market 111
NSAID classes 112
Anti-rheumatic NSAIDs 112
Coxibs 117
NSAIDs sales forecasts 123
Local anesthetics 123
Local anesthetics market analysis by medical applications 124
Leading brands in the local anesthetics market 125
Leading players in the local anesthetics market 129
Local anesthetics sales forecasts 130
Global pain management sales forecasts 131

Chapter 4 Pipeline analysis 134
Summary 134
Introduction 135
R&D trends 136
Reduced R&D activity from leading drug companies 136
Innovative drug delivery formulations and reformulations 137
Development of products associated with better side effect profiles 137
Flexibility in titration and dosing 137
Entry of biologics into the pain management space 137
Trial data bridging may reduce the number of studies required for
EU approval 138
Leading products in development 139
New chemical entities 140
Tapentadol 140
Tanezumab 142
Naproxcinod 144
Ralfinamide 146
Novel formulations 148
Remoxy 148
Embeda 150
Onsolis 152
Diractin 154
Rapinyl/Abstral 156
Eladur 159
Pipeline sales forecasts 160

Chapter 5 Competitive landscape 162
Summary 162
Introduction 163
Sales performance of leading players 164
Forecast sales performance of the leading players 166
Pfizer 167
Overview 167
Drug class focus 168
Key brands 169
Pipeline portfolio 171
Strategic and growth analysis 172
J&J 173
Overview 173
Drug class focus 174
Key brands 175
Pipeline portfolio 177
Strategic and growth analysis 177
Novartis 179
Overview 179
Drug class focus 180
Key brands 181
Strategic and growth analysis 182
GlaxoSmithKline 184
Overview 184
Drug class focus 184
Key brands 186
Strategic and growth analysis 187
Mundipharma 188
Overview 188
Drug class focus 189
Key brands 190
Strategic and growth analysis 191
Abbott 192
Overview 192
Drug class focus 192
Key brands 193
Strategic and growth analysis 194
Sanofi-Aventis 195
Overview 195
Drug class focus 196
Key brands 197
Strategic and growth analysis 198
UCB 199
Overview 199
Drug class focus 199
Key brands 200
Strategic and growth analysis 201
Teva 201
Overview 201
Drug class focus 202
Key brands 203
Strategic and growth analysis 204
Endo Pharma 205
Overview 205
Drug class focus 206
Licensing deals 206
Key brands 208
Strategic and growth analysis 209

Chapter 6 Appendix 212
IMS Data 212
M1A1 Antirheumatics non-steroidal plain 212
M1A2 Antirheumatics non-steroidal combination 212
M1A3 Coxibs plain 212
N1B1 Anesthetics local medical injection 212
N1B2 Anaesthetics local dental injection 212
N1B3 Anaesthetics local topical 212
N1B9 Anaesthetics local others 212
N2A0 Narcotic analgesics 213
N2B0 Non-narcotic analgesics 213
N2B1 Non-narcotic analgesics, prescription 213
N2B2 Non-narcotic analgesics, OTC 213
N3A0 Anti-epileptics 213
Glossary 214
Index 216

List of Figures
Figure 2.1: Factors involved in pain sensation 24
Figure 3.2: Regional shares (%) of the pain management market, 2007 67
Figure 3.3: Clinical profile of OxyContin CR 80
Figure 3.4: Clinical profile of Duragesic 84
Figure 3.5: Clinical profile of Topamax 95
Figure 3.6: Clinical profile of Lamictal 99
Figure 3.7: Clinical profile of Lyrica 103
Figure 3.8: Clinical profile of Voltaren 115
Figure 3.9: Clinical profile of Celebrex 120
Figure 3.10: Clinical profile of Lidoderm 127
Figure 4.11: Leading recently launched products and late-stage R&D compounds indicated for the treatment of pain, 2009 139
Figure 4.12: “Abuse-deterrent” formulation design of Embeda 151
Figure 5.13: Market dynamics of leading players in the global pain management market, 2006–07 165

List of Tables
Table 2.1: Estimated prevalence of neuropathic and nociceptive pain in the seven major
pharmaceutical markets, 2008 25
Table 2.2: Estimated prevalence of neuropathic lower back pain in the seven major
pharmaceutical markets, 2008 29
Table 2.3: Forecast prevalence of neuropathic lower back pain across the seven major markets,
2008–14 30
Table 2.4: Estimated prevalence of neuralgia/fibromyalgia pain in the seven major
pharmaceutical markets, 2008 33
Table 2.5: Forecast prevalence of neuralgia/fibromyalgia across the seven major markets, 2008–
14 34
Table 2.6: Estimated prevalence of diabetic neuropathic pain in the seven major pharmaceutical
markets, 2008 37
Table 2.7: Forecast prevalence of diabetic neuropathic pain across the seven major markets,
2008–14 38
Table 2.8: Estimated prevalence of multiple sclerosis in the seven major pharmaceutical markets,
2008 41
Table 2.9: Forecast prevalence of pain associated with multiple sclerosis across the seven major
markets, 2008–14 42
Table 2.10: Estimated prevalence of OA-related pain in the seven major pharmaceutical markets,
2008 45
Table 2.11: Estimated prevalence of RA pain in the seven major pharmaceutical markets, 2008 46
Table 2.12: Forecast prevalence of OA-related pain across the seven major markets, 2008–14 47
Table 2.13: Forecast prevalence of RA-related pain across the seven major markets, 2008–14 48
Table 2.14: Estimated prevalence of post-operative pain in the seven major pharmaceutical
markets, 2008 50
Table 2.15: Forecast prevalence of post-operative pain across the seven major markets, 2008–14 51
Table 2.16: Estimated prevalence of cancer-related pain in the seven major pharmaceutical
markets, 2008 54
Table 2.17: Forecast prevalence of early-stage cancer-related pain across the seven major markets,
2008–14 55
Table 2.18: Forecast prevalence of late-stage cancer-related pain across the seven major markets,
2008–14 56
Table 2.19: Estimated prevalence of HIV/AIDS-related neuropathic pain in the seven major
pharmaceutical markets, 2008 58
Table 2.20: Forecast prevalence of HIV/AIDS-related pain across the seven major markets, 2008–
14 59
Table 3.21: Licensing deals in the global pain management market 66
Table 3.22: Break-up of the global pain management market by drug class, 2006–07 68
Table 3.23: Leading brands in the global pain management market, 2006–07 70
Table 3.24: Drug classes in the global analgesics market, 2006–07 72
Table 3.25: Leading brands in the global analgesics market, 2006–07 73
Table 3.26: Leading players in the global analgesics market, 2006–07 75
Table 3.27: Leading brands in the global narcotic analgesics market, 2006–07 78
Table 3.28: Leading brands in the global non-narcotic analgesics market, 2006–07 88
Table 3.29: Competitive analysis of Tylenol and Efferalgan 90
Table 3.30: Sales forecasts of analgesics, 2007–14 91
Table 3.31: Leading brands in the global anticonvulsants market, 2006–07 93
Table 3.32: Leading anticonvulsant brands based on proportion of sales generated by prescriptions
for pain indications in the seven major markets, 2007 94
Table 3.33: Leading players in the global anticonvulsants market, 2006–07 105
Table 3.34: Sales forecast for the anticonvulsants, 2007–14 106
Table 3.35: Drug classes in the global NSAIDs market, 2006–07 108
Table 3.36: Leading brands in the global NSAIDs market, 2006–07 109
Table 3.37: Leading players in the global NSAIDs market, 2006–07 111
Table 3.38: Leading brands in the global anti-rheumatic NSAIDs market, 2006–07 113
Table 3.39: Leading brands in the global coxibs market, 2006–07 118
Table 3.40: Sales forecasts of NSAIDs, 2007–14 123
Table 3.41: Medical applications in the global local anesthetics market, 2006–07 124
Table 3.42: Leading brands in the global local anesthetics market, 2006–07 125
Table 3.43: Leading players in the global local anesthetics market, 2006–07 129
Table 3.44: Sales forecasts of local anesthetics, 2007–14 130
Table 3.45: Sales forecasts of the global pain management market, 2007–14 131
Table 4.46: An overview of tapentadol 140
Table 4.47: An overview of tanezumab 142
Table 4.48: An overview of naproxcinod 144
Table 4.49: An overview of ralfinamide 146
Table 4.50: An overview of Remoxy 148
Table 4.51: An overview of Embeda 150
Table 4.52: An overview of Onsolis 152
Table 4.53: An overview of Diractin 154
Table 4.54: An overview of Rapinyl/Abstral 156
Table 4.55: An overview of Eladur 159
Table 4.56: Sales forecasts of pipeline compounds, 2007–14 160
Table 5.57: Leading companies in the global pain management market, 164
Table 5.58: Pain management sales forecasts of the leading players in the market, 2007–14 166
Table 5.59: Pfizer’s pain management sales break-up based on drug class, 2007 168
Table 5.60: Pfizer’s leading pain management products, 2006–07 169
Table 5.61: Pfizer’s key pain management products under development, March 2009 171
Table 5.62: J&J’s pain management sales break-up based on drug class, 2007 174
Table 5.63: J&J’s leading pain management products, 2006–07 175
Table 5.64: J&J’s key pain management products under development, 177
Table 5.65: Novartis's pain management sales break-up based on drug class, 2007 180
Table 5.66: Novartis's leading pain management products, 2006–07 181
Table 5.67: GSK’s pain management sales break-up based on drug class, 2007 184
Table 5.68: GSK’s leading pain management products, 2006–07 186
Table 5.69: Mundipharma’s pain management sales break-up based on drug class, 2007 189
Table 5.70: Mundipharma’s leading pain management products, 2006–07 190
Table 5.71: Abbott’s pain management sales break-up based on drug class, 2007 192
Table 5.72: Abbott’s leading pain management products, 2006–07 193
Table 5.73: Sanofi-Aventis's pain management sales break-up based on drug class, 2007 196
Table 5.74: Sanofi–Aventis's leading pain management products, 2006–07 197
Table 5.75: UCB’s pain management sales break-up based on drug class, 2007 199
Table 5.76: UCB’s leading pain management products, 2006–07 200
Table 5.77: Teva’s pain management sales break-up based on drug class, 2007 202
Table 5.78: Teva’s leading pain management products, 2006–07 203
Table 5.79: Endo’s pain management sales break-up based on drug class, 2007 206
Table 5.80: Endo’s US pain management marketing licensing deals 207
Table 5.81: Endo’s leading pain management products, 2006–07 208