Neuropathic pain (NP) is a prominent form of pain associated with a variety of diseases and conditions, including cancer, diabetes, herpes zoster, chronic back pain, and multiple sclerosis. A growing NP patient population, the significant percentage of patients refractory to treatment, a high rate of polypharmacy, and large unmet need, in balance with the availability of multiple generic analgesics and well-established treatment options, combine to make the NP market one of modest commercial opportunity for pain therapies, particularly those with novel mechanisms of action. Antiepileptic drugs (AEDs), such as Pfizer’s Lyrica (pregabalin) and gabapentin (Pfizer’s Neurontin, generics), and antidepressants, such as Eli Lilly’s Cymbalta (duloxetine, generics), are the most commonly used drugs in first-line treatment of NP. Among topical anesthetics, the 5% lidocaine patch (Endo’s Lidoderm, generics) has emerged as an early-line therapy for NP patients who present with highly localized peripheral pain; the newer Qutenza (Acorda Therapeutics’ 8% capsaicin patch) has seen limited uptake since its U.S. launch for PHN in 2010. Nevertheless, because no single therapy provides more than partial analgesia, NP treatment is characterized by a high rate of polypharmacy across several drug classes. Other drug classes frequently prescribed for this patient population include NSAIDs, dual-acting opioid analgesics (e.g., tramadol [generics], Nucynta ER [Depomed’s tapentadol ER]), and, for the most severe pain, opioid analgesics (e.g., oxycodone CR [Purdue’s OxyContin]).
For this report, we surveyed 49 primary care physicians (PCPs), 50 pain specialists, 51 neurologists, and 30 managed care organization (MCO) pharmacy and medical directors to assess their attitudes, expectations, receptivity, and reservations regarding current, recently approved, and emerging NP therapies (including Daichii-Sankyo’s AED mirogabalin, Pfizer’s AED pregabalin CR, BioDelivery Sciences International’s topical clonidine gel, Impax/Durect’s transdermal bupivacaine patch, Immune Pharmaceutical’s topical ketamine/amitriptyline cream [AmiKet], and Biogen’s oral subtype-selective sodium-channel antagonist CNV-1014802).