The Global Market for Pain Management Drugs and Devices

The Global Market for Pain Management Drugs and Devices

INTRODUCTION

STUDY GOALS AND OBJECTIVES

This BCC Research report, The Global Market for Pain Management Drugs and Devices, provides an overview of products included in this market, and detailed analyses of markets and competitive environments. The study includes information about significant products, players, issues and trends, regulatory issues, and other information affecting the pain management industry.

REASONS FOR DOING THE STUDY

This study will provide the reader with the knowledge to adequately view and assess pain management and the problems that the healthcare industry faces as well as provide insights into the market potentials. This covers a wide variety of treatments and products that many people worldwide rely on.

SCOPE AND FORMAT

This BCC Research report is designed to be a helpful business tool that will provide a thorough evaluation of the markets for pain management. The geographical scope of this study is global with a U.S. emphasis. This study will address acute versus chronic pain, treatments, and regulatory issues facing healthcare workers. Also provided is detailed information based on product categories, use of products, forecasts, and competitive analyses.

The report identifies two general segments of pain management:
- Pharmaceuticals.
- Devices.

Within the pharmaceuticals segment several sub-segments are discussed in detail including:
- Narcotic pain management.
- Non-narcotic pain management.
- Antimigraine treatments.
- Anesthetics.
- Other drugs (including fibromyalgia treatments).

The device segment covers several product lines and specifically targets the largest product segments including:
- TENS and neuromuscular stimulators.
- Spinal cord stimulators.
- Other products (including electromagnetic therapies and other treatments).

Each market segment provides detailed information based on product categories, product use, forecasts, and competitive analyses.

METHODOLOGY

The information for this BCC report was obtained through primary and secondary data-collection methods. Primary methods included interviews with approximately 35 key executives, physicians, nurses, product managers, and other professionals involved in the pain treatment industry. Secondary methods included published literature in the area of pain management, investment reports, company literature, and various related journals.

Market data for this report pertains to the global market and uses U.S. dollars at the manufacturers’ level. The base year of the report is 2012, with historical data provided for 2008 through 2011, and forecast data provided through 2017. Historical, base year and forecast data are provided for each market segment of the report. Growth rates are determined through a compilation of data, including past trends, future trends, demographics, incidence, mortality, products in research and development, and current product growth, etc. Competitor market share estimates are provided for each market segment for the 2012 base year.

ANALYST CREDENTIALS

Melissa Elder is an experienced healthcare market analyst specializing in prescription and over-the-counter pharmaceuticals, medical devices, and emerging healthcare technologies. Ms. Elder has nearly 20 years of experience in the healthcare industry, specializing in market research for the past 14 years. This experience has given her substantial insight into pharmaceutical market analysis. Her work in the medical community, including emergency room medical training and healthcare information system coordination, has enhanced her ability to provide insight into many healthcare markets.

REPORT HIGHLIGHTS

This report provides:
- An overview of the global market for pain management drugs, which will address acute vs. chronic pain, treatments, and issues facing healthcare workers.
- Analyses of global market trends, with data from 2012, and projections of compound annual growth rates (CAGRs) through 2017.
- Examination of product categories, use of products, and the competitive landscape.
- Coverage of several significant market trends, including undertreatment issues, professional issues, managed care pain issues, trends in new therapies, product pipelines, generic participation, pain research, drug delivery, and patent expirations.
- Discussion of new regulatory requirements.
- Comprehensive company profiles of major players in the industry.

TABLE OF CONTENTS

CHAPTER 1 INTRODUCTION 1
STUDY GOALS AND OBJECTIVES 1
REASONS FOR DOING THE STUDY 1
SCOPE AND FORMAT 1
METHODOLOGY 2
ANALYST CREDENTIALS 2
RELATED BCC STUDIES 2
BCC ON-LINE SERVICES 2
DISCLAIMER 3

CHAPTER 2 SUMMARY 5
OVERVIEW 5
GENERAL PAIN TERMINOLOGY 5
MAJOR MARKETS SUMMARY 6
SUMMARY TABLE GLOBAL PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES
MARKET, 2012 AND 2017 ($ MILLIONS) 7
SUMMARY FIGURE GLOBAL PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES
MARKET, 2012 AND 2017 ($ MILLIONS) 7
MARKET TRENDS 7
UNDER-TREATMENT ISSUES 8
PROFESSIONAL PAIN TREATMENT ISSUES 8
ACCESS TO CARE 8
GLOBAL HEALTHCARE SYSTEMS 8
FDA APPROVAL REQUIREMENTS FOR PAIN THERAPIES 8
DRUG DELIVERY SYSTEMS 9
COMPETITORS 9

CHAPTER 3 INDUSTRY OVERVIEW 11
HISTORY OF PAIN AND PAIN TREATMENT 11
THE PERCEPTION OF PAIN 12
Types of Pain 12
Acute Pain 12
Chronic Pain 13
ASSESSMENT OF PAIN 13
Subjective 13
Objective 13
TABLE 1 OBJECTIVE SIGNS OF PAIN 14
HOW PAIN IS DIAGNOSED 14
THERMOGRAPHY 15
HOW PAIN IS TREATED 15
FIGURE 1 PAIN-MANAGEMENT TECHNIQUES 15
DEMOGRAPHICS AND AGING POPULATIONS 20
Global Demographics 20
TABLE 2 ESTIMATED GLOBAL POPULATION AND ANNUAL GROWTH BY SELECTED AGE
GROUP AND SELECTED YEARS, THROUGH 2030 (MILLIONS) 21
FIGURE 2 ESTIMATED GLOBAL POPULATION BY SELECTED AGE GROUP AND SELECTED
YEARS, 2000-2030 (MILLIONS) 21
TABLE 3 GLOBAL POPULATION BY SELECTED COUNTRY, THROUGH 2015 (MILLIONS) 22
FIGURE 3 GLOBAL POPULATION BY SELECTED COUNTRY, 2010 AND PROJECTED 2015
(MILLIONS) 22
Global Life Expectancy 23
TABLE 4 GLOBAL LIFE EXPECTANCY AT BIRTH BY SELECTED COUNTRY, 1980 AND 2010
(YEARS) 23
FIGURE 4 GLOBAL LIFE EXPECTANCY AT BIRTH BY SELECTED COUNTRY, 1980 AND 2010
(YEARS) 24
GLOBAL PAIN MANAGEMENT 24
FIGURE 5 GLOBAL CANCER DEATHS BY TYPE, 2008 (THOUSANDS) 25
INCIDENCE OF PAIN 26
PREVALENCE OF PAIN 26
Severe Headache or Migraine, Low Back, and Neck Pain 26
TABLE 5 SEVERE HEADACHE OR MIGRAINE, LOW BACK PAIN, AND NECK PAIN AMONG
ADULTS 18 YEARS OF AGE AND OVER*, 2005-2009 (%) 26
FIGURE 6 SEVERE HEADACHE OR MIGRAINE, LOW BACK PAIN, AND NECK PAIN AMONG
ADULTS 18 YEARS OF AGE AND OVER*, 2005-2009 (%) 27
Orthopedic Pain 28
Osteoarthritis 28
Rheumatoid Arthritis 28
Ankylosing Spondylitis 28
Fibromyalgia 29
Gout 29
Scleroderma 29
Lupus 29
Bursitis and Tendonitis 29
Osteoporosis 30
Low Bone Mass 30
TABLE 6 ESTIMATED* PREVALENCE/INCIDENCE OF CONDITIONS AFFECTING THE
WORLDWIDE ORTHOPEDIC INDUSTRY, AVERAGE FIGURE, 2008-2010 30
FIGURE 7 ESTIMATED* PREVALENCE/INCIDENCE OF CONDITIONS AFFECTING THE
WORLDWIDE ORTHOPEDIC INDUSTRY, AVERAGE FIGURE 2008-2010 31
Cancer Pain 31
FIGURE 8 CAUSES OF CANCER PAIN 32
Pain Management in Cancer 33
TABLE 7 CANCER PAIN MEDICATION 33
Description of Some of Key Medications for Cancer Pain Control 34
Morphine 34
Fentanyl 34
Hydromorphone 34
Methadone 34
Buprenorphine 35
Oxycodone 35
Tapentadol 35
HIV/AIDS Related Pain 35
TABLE 8 ESTIMATED HIV REPORTED CASES BY REGION, 2011 36
FIGURE 9 ADULT PREVALENCE RATE, 2011 (%) 36
Burn Pain 36
Burn Classifications 37
TABLE 9 BURN CLASSIFICATIONS 37
Stages of Burn Healing 38
Challenges Associated with Burn Pain 39
Burn Pain Management 39
FIGURE 10 BURN PAIN MANAGEMENT APPROACH 40
Dental Pain 40
Treatment for Dental Pain 41
Obstetrics Pain 41
TABLE 10 BIRTH RATES AND BIRTHS BY COUNTRY, 2010 ESTIMATES 42
FIGURE 11 BIRTH RATES AND BIRTHS BY COUNTRY, 2010 ESTIMATES 42
Surgical pain 42
U.S. Surgical Procedures 43
TABLE 11 U.S. SURGICAL PROCEDURES 44
Global Surgical Procedures 44
TABLE 12 SELECT SURGICAL PROCEDURES FOR GERMANY, UNITED KINGDOM, AND
FRANCE 45
GENDER AND PAIN 45
TABLE 13 PAIN BY SELECTED CATEGORY AND GENDER IN THE 18+ U.S. POPULATION*
(THOUSANDS) 46
FIGURE 12 PAIN BY SELECTED CATEGORY AND GENDER IN THE 18+ U.S. POPULATION*
(THOUSANDS) 47
OTHER INFLUENCES DETERMINING HOW PAIN IS FELT AMONG INDIVIDUALS 47
Objective Pain Measurement 48
PEDIATRIC PAIN 48

CHAPTER 4 INDUSTRY TRENDS 51
OVERVIEW 51
UNDERTREATMENT ISSUES 51
TREATMENT OF PAIN AND ISSUES FACING THE PROFESSIONAL SEGMENT 53
TABLE 14 AVAILABILITY OF EDUCATION IN PAIN MANAGEMENT BY SELECT
REGION/COUNTRY 55
PRESCRIPTION DRUG MONITORING PROGRAMS 56
TABLE 15 TOTAL NUMBER OF ABUSE TREATMENT FACILITIES AND CLIENTS, 2000-2010 56
FIGURE 13 TOTAL NUMBER OF ABUSE TREATMENT FACILITIES, 2000-2010 56
FIGURE 14 TOTAL NUMBER OF ABUSE TREATMENT CLIENTS, 2000-2010 57
TABLE 16 BENEFITS OF PRESCRIPTION MONITORING PROGRAMS FOR MEDICAL BOARDS 58
TABLE 17 STATES WITH ELECTRONIC PRESCRIPTION MONITORING PROGRAMS 58
TABLE 18 STATE CONTROLLED SUBSTANCES SCHEDULING AUTHORITIES AND OTHER
CONTACT INFORMATION 60
TABLE 19 NURSE CONTINUING EDUCATION REQUIREMENTS FOR PAIN MANAGEMENT, BY
REQUIRING STATE 73
ACCESS TO CARE 73
PHYSICIAN TO PATIENT RATIOS 74
TABLE 20 PHYSICIANS PER 1,000 POPULATION BY YEAR AND COUNTRY (THOUSANDS) 74
FIGURE 15 PHYSICIANS PER 1,000 POPULATION BY COUNTRY, 2010* 75
TABLE 21 NUMBER OF PHYSICIAN PER 100,000 RESIDENT POPULATION, UNITED STATES,
2009 76
FIGURE 16 NUMBER OF PHYSICIANS PER 100,000 RESIDENT POPULATION, UNITED STATES
2009 76
ACCESS TO PALLIATIVE CARE 77
AVAILABILITY OF MEDICATIONS 78
TABLE 22 AVAILABILITY OF INJECTABLE MORPHINE BY COUNTRY 78
TABLE 23 AVAILABILITY OF ORAL MORPHINE IN HOSPICE-TYPE SETTINGS BY COUNTRY 79
GOVERNMENT RESTRICTIONS AND SUPPORT 80
Drug Supply 80
Single Convention on Narcotic Drugs 81
Government Subsidies 81
PUBLIC HEALTHCARE SYSTEMS AROUND THE WORLD 81
TABLE 24 WORLD HEALTH ORGANIZATION RANKING OF HEALTHCARE SYSTEMS, TOP 50
(2000) 82
RISING HEALTHCARE COSTS 83
TABLE 25 HEALTH EXPENDITURES AS PERCENTAGE OF GDP BY COUNTRY, 1980 TO 2010 83
AVERAGE LENGTH OF STAY 83
TABLE 26 HOSPITAL USAGE STATISTICS, AVERAGE 2000-2010 (DAYS) 84
FIGURE 17 HOSPITAL USAGE STATISTICS (DAYS) 84
MANAGED CARE PAIN MANAGEMENT ISSUES 85
FDA APPROVAL REQUIREMENTS FOR PAIN THERAPIES 85
NEW RULES AND LEGISLATION 86
Risk Evaluation and Mitigation Strategy (REMS) 86
TABLE 27 LIST OF EXTENDED-RELEASE AND LONG-ACTING OPIOID PRODUCTS REQUIRED
TO HAVE AN OPIOID REMS, BRAND NAME PRODUCTS 86
TABLE 28 LIST OF EXTENDED-RELEASE AND LONG-ACTING OPIOID PRODUCTS REQUIRED
TO HAVE AN OPIOID REMS, GENERIC NAME PRODUCTS 87
TABLE 29 LIST OF TRANSMUCOSAL IMMEDIATE-RELEASE FENTANYL PRODUCTS
REQUIRED TO HAVE TIRF REMS ACCESS PROGRAM 88
Acetaminophen and FDA Changes 88
TABLE 30 LIST OF MARKETED ACETAMINOPHEN-CONTAINING PRESCRIPTION PRODUCTS 89
DRUG DELIVERY SYSTEMS 90
ORAL AND EXTENDED RELEASE 90
TOPICAL AND TRANSDERMAL 90
INTRAVENOUS 91
INTRANASAL 91
PATIENT-CONTROLLED ANALGESIA 91
IONTOPHORESIS 91
TABLE 31 ADVANTAGES OF IONTOPHORETIC DRUG DELIVERY 92
ELECTROMECHANICAL TRANSPORT 92

CHAPTER 5 TREATING PAIN 94
PHARMACEUTICAL PAIN MANAGEMENT 94
PRESCRIPTION PAIN MANAGEMENT PRODUCTS 94
TABLE 32 RECENT FDA APPLICATIONS/APPROVALS, JANUARY 2010-OCTOBER 2012 94
Analgesic Drugs 96
Non-Narcotic 97
Narcotic 97
Full and Partial Agonists 99
Agonist-Antagonists 100
Nonsteroid Anti-inflammatory Drugs 101
Anti-migraine Drugs 102
Antidepressant, Anticonvulsants, and Other Pain Relieving Drugs 103
ANESTHETICS 103
General 103
TABLE 33 MOST COMMONLY USED GENERAL ANESTHETIC AGENTS 104
Local/Regional 105
Topical 105
OVER-THE-COUNTER PAIN MANAGEMENT PRODUCTS 105
ANALGESIC DRUGS 105
TABLE 34 ACETAMINOPHEN AND ACETAMINOPHEN COMBINATION PRODUCTS 106
NONSTEROID ANTI-INFLAMMATORY DRUGS 106
Aspirin Products and Aspirin Combination Products 107
TABLE 35 ASPIRIN AND ASPIRIN COMBINATION PRODUCTS 107
Ibuprofen and Ibuprofen Combination Products 107
TABLE 36 IBUPROFEN AND IBUPROFEN COMBINATION PRODUCTS 108
Ketoprofen Products 108
TABLE 37 KETOPROFEN PRODUCTS 108
Naproxen Compounds 108
TABLE 38 OTC NONSTEROID ANTI-INFLAMMATORIES 109
ANTI-MIGRAINE DRUGS 109
TABLE 39 ANTI-MIGRAINE PRODUCTS 109
TOPICAL ANESTHETIC DRUGS 109
TABLE 40 TOPICAL ANESTHETIC PRODUCTS 110
PAIN MANAGEMENT DEVICES 110
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATORS 111
PAIN TEM 112
SPINAL CORD STIMULATORS 112
NEUROMUSCULAR STIMULATORS 113
OTHER PAIN MANAGEMENT DEVICES 114
Electromagnetic Therapy 115
PAIN MANAGEMENT PROCEDURES: STEROIDS, ENDOSCOPY, FLUOROSCOPY 116
ALTERNATIVE METHODS OF PAIN MANAGEMENT 116
PSYCHOLOGICAL THERAPIES 118
Biofeedback 118
Hypnosis 118
Behavior Modification/Operant Conditioning 119
Relaxation and Stress Management Training 119
Imagery 120
Autogenic Training 120
Psychosocial Interventions 120
Distraction and Reframing 120
PHYSICAL THERAPIES 121
Ice 121
Warm Bath 121
Massage 121
Joint Mobilization 122
Manipulation 122
Traction 122
Acupuncture/Acupressure 122
Laser Therapy 123
Surgery 124
Radiation Therapy 124
Radio-Frequency Neuroablation, Epiduroscopy 124
TABLE 41 UNITED STATES: ADULTS 18 YEARS AND OVER WHO USED COMPLEMENTARY
AND ALTERNATIVE MEDICINE (CAM) IN THE PAST 12 MONTHS BY TYPE AND THERAPY,
2002-2012 (THOUSANDS OF PEOPLE) 125
FIGURE 18 UNITED STATES: ADULTS 18 YEARS AND OVER WHO USED COMPLEMENTARY
AND ALTERNATIVE MEDICINE (CAM) IN THE PAST 12 MONTHS BY TYPE AND THERAPY,
2002-2012 (THOUSANDS OF PEOPLE) 125
PAIN MANAGEMENT SERVICES AND ORGANIZATIONS 126
HOME CARE 126
HOSPICE 127
FIGURE 19 TOTAL HOSPICE PATIENTS SERVED BY YEAR, 2006-2010 (TOTAL PATIENTS
SERVED, ESTIMATE) 128
TABLE 42 HOSPICE STATISTICS, PATIENTS BY CHARACTERISTICS, 2009 AND 2010 (% OF
TOTAL) 129
FIGURE 20 TOTAL HOSPICE PATIENTS BY GENDER, 2009 AND 2010 (% OF TOTAL) 129
FIGURE 21 TOTAL HOSPICE PATIENTS BY AGE, 2009 AND 2010 (% OF TOTAL) 130
TABLE 43 HOSPICE STATISTICS, PATIENTS BY PRIMARY DIAGNOSIS (% OF TOTAL) 130
FIGURE 22 TOTAL HOSPICE PATIENTS BY PRIMARY DIAGNOSIS, 2009 AND 2010 (% OF
TOTAL) 131
NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION 132
TABLE 44 NHPCO COMMITTEES AND TASK FORCES 132
HOSPITALS 133
TABLE 45 ESTIMATED NUMBER OF REGISTERED HOSPITALS BY SELECTED COUNTRY, 2010
ESTIMATES 133
TABLE 46 TOTAL NUMBER OF REGISTERED U.S. HOSPITALS BY TYPE, 2010 134
Hospital Departments 134
Emergency Rooms (ER) 134
Critical-Care Units (CCU) 134
PAIN CLINICS 135
SKILLED NURSING FACILITIES 136

CHAPTER 6 PRESCRIPTION PAIN MANAGEMENT MARKET SIZE AND ANALYSIS 138
TOTAL MARKET 138
PRESCRIPTION PAIN MARKETS BY PRODUCT TYPE 138
TABLE 47 GLOBAL PRESCRIPTION PAIN MANAGEMENT PHARMACEUTICALS MARKET AT
MANUFACTURERS' SALES LEVELS, THROUGH 2017 ($ MILLIONS) 139
FIGURE 23 GLOBAL PRESCRIPTION PAIN MANAGEMENT PHARMACEUTICALS MARKET AT
MANUFACTURERS' SALES LEVELS, 2008-2017 ($ MILLIONS) 139
NARCOTIC ANALGESICS 139
NON-NARCOTIC ANALGESICS 140
ANTIMIGRAINE AGENTS 140
ANESTHETICS 140
OTHER DRUG CLASSES 141
MARKET PARTICIPANTS 141
NARCOTIC/NON-NARCOTIC MARKET SHARE 141
TABLE 48 PRESCRIPTION NARCOTIC AND NON-NARCOTIC MANUFACTURER MARKET
SHARE BY REVENUE, 2012 ($ MILLIONS) 142
FIGURE 24 PRESCRIPTION NARCOTIC AND NON-NARCOTIC MANUFACTURER MARKET
SHARE BY REVENUE, 2012 ($ MILLIONS) 142
MIGRAINE TREATMENT MARKET SHARE 142
TABLE 49 PRESCRIPTION ANTI-MIGRAINE DRUG MANUFACTURER MARKET SHARE BY
REVENUE, 2012 ($ MILLIONS/%) 143
FIGURE 25 PRESCRIPTION ANTI-MIGRAINE DRUG MANUFACTURER MARKET SHARE BY
REVENUE, 2012 (%) 144
ANESTHETIC MARKET SHARE 144
TABLE 50 PRESCRIPTION ANESTHETIC MANUFACTURER MARKET SHARE BY REVENUE,
2012 ($ MILLIONS) 145
FIGURE 26 PRESCRIPTION ANESTHETIC MANUFACTURER MARKET SHARE BY REVENUE,
2012 (%) 145
FUTURE MARKET ANALYSIS 145

CHAPTER 7 PAIN MANAGEMENT DEVICE MARKET SIZE AND ANALYSIS 147
TOTAL PAIN MANAGEMENT DEVICE MARKET 147
PAIN MARKETS BY PRODUCT TYPE 147
TABLE 51 GLOBAL PAIN MANAGEMENT DEVICES MARKET BY PRODUCT TYPE, THROUGH
2017 ($ MILLIONS) 148
FIGURE 27 GLOBAL PAIN MANAGEMENT DEVICES MARKET BY PRODUCT TYPE, 2008-2017
($ MILLIONS) 148
SPINAL CORD STIMULATORS 148
NEUROSTIMULATOR/TENS UNITS 149
OTHER PAIN TREATMENT DEVICES 149
MARKET PARTICIPANTS 149
NEUROMUSCULAR STIMULATOR/TENS MARKET SHARE 149
TABLE 52 GLOBAL NEUROMUSCULAR STIMULATOR/TENS—ELECTROTHERAPY
DEVICES—MANUFACTURER MARKET SHARE, 2012 ($ MILLIONS) 150
FIGURE 28 GLOBAL NEUROMUSCULAR STIMULATOR/TENS—ELECTROTHERAPY
DEVICES—MANUFACTURER MARKET SHARE, 2012 (%) 150
SPINAL CORD STIMULATOR MARKET SHARE 150
TABLE 53 GLOBAL SPINAL CORD STIMULATOR MANUFACTURER MARKET SHARE, 2012 ($
MILLIONS) 151
FIGURE 29 GLOBAL SPINAL CORD STIMULATOR MANUFACTURER MARKET SHARE, 2012 (%) 151
FUTURE MARKET ANALYSIS 151


CHAPTER 8 TOTAL MARKET SUMMARY 153
TOTAL PAIN MANAGEMENT MARKET 153
TABLE 54 PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES MARKET BY REVENUE,
THROUGH 2017 ($ MILLIONS) 153
FIGURE 30 PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES MARKET BY REVENUE,
2008-2017 ($ MILLIONS) 153
MARKET PERCENTAGE BY PRODUCT TYPE 154
TABLE 55 PERCENT DISTRIBUTION OF THE GLOBAL PAIN MANAGEMENT MARKET BY
SEGMENT, 2012 (%/$ MILLIONS) 154
FIGURE 31 PERCENT DISTRIBUTION OF THE GLOBAL PAIN MANAGEMENT MARKET BY
SEGMENT, 2012 (%) 154
MARKETS BY WORLD REGION 155
TABLE 56 DISTRIBUTION OF GLOBAL PAIN MANAGEMENT REVENUES BY REGION, 2012
(%/$ MILLIONS) 156
FIGURE 32 PERCENTAGE DISTRIBUTION OF GLOBAL PAIN MANAGEMENT SHARES BY
REGION, 2012 (%) 156

CHAPTER 9 INDUSTRY DEVELOPMENTS 158
TIMELINE OF RECENT EVENTS AND DEVELOPMENTS 158
THE PIPELINE 159
TABLE 57 SELECTED PAIN-MANAGEMENT DRUG PIPELINES 159
NEW DEVELOPMENTS IN BREAKTHROUGH CANCER PAIN 162
NEW DEVELOPMENTS IN TREATING NEUROPATHIC PAIN 162
DEVELOPMENTS IN OPIOID-INDUCED CONSTIPATION AND REDUCED COMPLIANCE 163
FUTURE OF PAIN RESEARCH 164
PATIENT OUTCOMES RESEARCH 166
SELECTED PAIN-RELATED ACQUISITIONS AND ALLIANCES 166
JANUARY-OCTOBER 2012 166
2000-2011 167
DRUG PATENTS FOR SELECTED THERAPIES 167
TABLE 58 U.S. PATENT EXPIRATION DATES FOR SELECT PAIN DRUGS 167
IMPACT OF GENERIC PARTICIPATION 168
TABLE 59 FIRST TIME PRESCRIPTION GENERIC PAIN MANAGEMENT AND APPROVALS,
JANUARY 2004-OCTOBER 2012 169

CHAPTER 10 COMPANY PROFILES 174
PHARMACEUTICAL AND DEVICE PAIN MANAGEMENT MANUFACTURERS 174
ABBOTT LABORATORIES 174
ASTRAZENECA 174
BAXTER INTERNATIONAL INC. 175
DJO GLOBAL, INC. 175
ELI LILLY & CO. 175
ENDO PHARMACEUTICALS, INC. 176
GLAXOSMITHKLINE 176
JOHNSON & JOHNSON 177
MEDTRONIC, INC. 178
MERCK & CO. INC. 178
NOVARTIS INTERNATIONAL AG 179
PFIZER 179
PURDUE PHARMACEUTICALS LP 180
ST. JUDE MEDICAL, INC. 180

CHAPTER 11 APPENDIX I: SELECTED PAIN MANAGEMENT CLINICS-UNITED STATES-BY
STATE 183
ALABAMA PAIN CLINICS 183
CALIFORNIA PAIN CLINICS 184
COLORADO PAIN CLINICS 192
DELAWARE PAIN CLINICS 193
FLORIDA PAIN CLINICS 193
HAWAII PAIN CLINICS 199
IOWA PAIN CLINICS 199
MAINE PAIN CLINICS 200
NEVADA PAIN CLINICS 200
OREGON PAIN CLINICS 201
PENNSYLVANIA PAIN CLINICS 202
RHODE ISLAND PAIN CLINICS 205
SOUTH DAKOTA PAIN CLINICS 205
TEXAS PAIN CLINICS 206
WASHINGTON PAIN CLINICS 208

CHAPTER 12 APPENDIX II: GLOBAL SELECTED PAIN MANAGEMENT CLINICS, BY COUNTRY 212
ARGENTINA PAIN CLINICS 212
AUSTRALIA PAIN CLINICS 213
BRAZIL PAIN CLINICS 214
GERMANY PAIN CLINICS 215
INDIA PAIN CLINICS 215
ITALY PAIN CLINICS 218
SINGAPORE PAIN CLINICS 218
UNITED KINGDOM PAIN CLINICS 219


CHAPTER 13 APPENDIX III: U.S. PAIN SOCIETIES AND ASSOCIATIONS 222

CHAPTER 14 APPENDIX IV: INTERNATIONAL ASSOCIATIONS AND ORGANIZATIONS 224

CHAPTER 15 APPENDIX V: COMPANY NAMES AND ADDRESSES 226
PAIN MANAGEMENT PHARMACEUTICAL MANUFACTURERS 226



LIST OF TABLES

SUMMARY TABLE GLOBAL PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES MARKET,
2012 AND 2017 ($ MILLIONS) 7
TABLE 1 OBJECTIVE SIGNS OF PAIN 14
TABLE 2 ESTIMATED GLOBAL POPULATION AND ANNUAL GROWTH BY SELECTED AGE
GROUP AND SELECTED YEARS, THROUGH 2030 (MILLIONS) 21
TABLE 3 GLOBAL POPULATION BY SELECTED COUNTRY, THROUGH 2015 (MILLIONS) 22
TABLE 4 GLOBAL LIFE EXPECTANCY AT BIRTH BY SELECTED COUNTRY, 1980 AND 2010
(YEARS) 23
TABLE 5 SEVERE HEADACHE OR MIGRAINE, LOW BACK PAIN, AND NECK PAIN AMONG
ADULTS 18 YEARS OF AGE AND OVER*, 2005-2009 (%) 26
TABLE 6 ESTIMATED* PREVALENCE/INCIDENCE OF CONDITIONS AFFECTING THE
WORLDWIDE ORTHOPEDIC INDUSTRY, AVERAGE FIGURE, 2008-2010 30
TABLE 7 CANCER PAIN MEDICATION 33
TABLE 8 ESTIMATED HIV REPORTED CASES BY REGION, 2011 36
TABLE 9 BURN CLASSIFICATIONS 37
TABLE 10 BIRTH RATES AND BIRTHS BY COUNTRY, 2010 ESTIMATES 42
TABLE 11 U.S. SURGICAL PROCEDURES 44
TABLE 12 SELECT SURGICAL PROCEDURES FOR GERMANY, UNITED KINGDOM, AND
FRANCE 45
TABLE 13 PAIN BY SELECTED CATEGORY AND GENDER IN THE 18+ U.S. POPULATION*
(THOUSANDS) 46
TABLE 14 AVAILABILITY OF EDUCATION IN PAIN MANAGEMENT BY SELECT
REGION/COUNTRY 55
TABLE 15 TOTAL NUMBER OF ABUSE TREATMENT FACILITIES AND CLIENTS, 2000-2010 56
TABLE 16 BENEFITS OF PRESCRIPTION MONITORING PROGRAMS FOR MEDICAL BOARDS 58
TABLE 17 STATES WITH ELECTRONIC PRESCRIPTION MONITORING PROGRAMS 58
TABLE 18 STATE CONTROLLED SUBSTANCES SCHEDULING AUTHORITIES AND OTHER
CONTACT INFORMATION 60
TABLE 19 NURSE CONTINUING EDUCATION REQUIREMENTS FOR PAIN MANAGEMENT, BY
REQUIRING STATE 73
TABLE 20 PHYSICIANS PER 1,000 POPULATION BY YEAR AND COUNTRY (THOUSANDS) 74
TABLE 21 NUMBER OF PHYSICIAN PER 100,000 RESIDENT POPULATION, UNITED STATES,
2009 76
TABLE 22 AVAILABILITY OF INJECTABLE MORPHINE BY COUNTRY 78
TABLE 23 AVAILABILITY OF ORAL MORPHINE IN HOSPICE-TYPE SETTINGS BY COUNTRY 79
TABLE 24 WORLD HEALTH ORGANIZATION RANKING OF HEALTHCARE SYSTEMS, TOP 50
(2000) 82
TABLE 25 HEALTH EXPENDITURES AS PERCENTAGE OF GDP BY COUNTRY, 1980 TO 2010 83
TABLE 26 HOSPITAL USAGE STATISTICS, AVERAGE 2000-2010 (DAYS) 84
TABLE 27 LIST OF EXTENDED-RELEASE AND LONG-ACTING OPIOID PRODUCTS REQUIRED
TO HAVE AN OPIOID REMS, BRAND NAME PRODUCTS 86
TABLE 28 LIST OF EXTENDED-RELEASE AND LONG-ACTING OPIOID PRODUCTS REQUIRED
TO HAVE AN OPIOID REMS, GENERIC NAME PRODUCTS 87
TABLE 29 LIST OF TRANSMUCOSAL IMMEDIATE-RELEASE FENTANYL PRODUCTS REQUIRED
TO HAVE TIRF REMS ACCESS PROGRAM 88
TABLE 30 LIST OF MARKETED ACETAMINOPHEN-CONTAINING PRESCRIPTION PRODUCTS 89
TABLE 31 ADVANTAGES OF IONTOPHORETIC DRUG DELIVERY 92
TABLE 32 RECENT FDA APPLICATIONS/APPROVALS, JANUARY 2010-OCTOBER 2012 94
TABLE 33 MOST COMMONLY USED GENERAL ANESTHETIC AGENTS 104
TABLE 34 ACETAMINOPHEN AND ACETAMINOPHEN COMBINATION PRODUCTS 106
TABLE 35 ASPIRIN AND ASPIRIN COMBINATION PRODUCTS 107
TABLE 36 IBUPROFEN AND IBUPROFEN COMBINATION PRODUCTS 108
TABLE 37 KETOPROFEN PRODUCTS 108
TABLE 38 OTC NONSTEROID ANTI-INFLAMMATORIES 109
TABLE 39 ANTI-MIGRAINE PRODUCTS 109
TABLE 40 TOPICAL ANESTHETIC PRODUCTS 110
TABLE 41 UNITED STATES: ADULTS 18 YEARS AND OVER WHO USED COMPLEMENTARY AND
ALTERNATIVE MEDICINE (CAM) IN THE PAST 12 MONTHS BY TYPE AND THERAPY, 2002-2012
(THOUSANDS OF PEOPLE) 125
TABLE 42 HOSPICE STATISTICS, PATIENTS BY CHARACTERISTICS, 2009 AND 2010 (% OF
TOTAL) 129
TABLE 43 HOSPICE STATISTICS, PATIENTS BY PRIMARY DIAGNOSIS (% OF TOTAL) 130
TABLE 44 NHPCO COMMITTEES AND TASK FORCES 132
TABLE 45 ESTIMATED NUMBER OF REGISTERED HOSPITALS BY SELECTED COUNTRY, 2010
ESTIMATES 133
TABLE 46 TOTAL NUMBER OF REGISTERED U.S. HOSPITALS BY TYPE, 2010 134
TABLE 47 GLOBAL PRESCRIPTION PAIN MANAGEMENT PHARMACEUTICALS MARKET AT
MANUFACTURERS' SALES LEVELS, THROUGH 2017 ($ MILLIONS) 139
TABLE 48 PRESCRIPTION NARCOTIC AND NON-NARCOTIC MANUFACTURER MARKET SHARE
BY REVENUE, 2012 ($ MILLIONS) 142
TABLE 49 PRESCRIPTION ANTI-MIGRAINE DRUG MANUFACTURER MARKET SHARE BY
REVENUE, 2012 ($ MILLIONS/%) 143
TABLE 50 PRESCRIPTION ANESTHETIC MANUFACTURER MARKET SHARE BY REVENUE, 2012
($ MILLIONS) 145
TABLE 51 GLOBAL PAIN MANAGEMENT DEVICES MARKET BY PRODUCT TYPE, THROUGH
2017 ($ MILLIONS) 148
TABLE 52 GLOBAL NEUROMUSCULAR STIMULATOR/TENS—ELECTROTHERAPY
DEVICES—MANUFACTURER MARKET SHARE, 2012 ($ MILLIONS) 150
TABLE 53 GLOBAL SPINAL CORD STIMULATOR MANUFACTURER MARKET SHARE, 2012 ($
MILLIONS) 151
TABLE 54 PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES MARKET BY REVENUE,
THROUGH 2017 ($ MILLIONS) 153
TABLE 55 PERCENT DISTRIBUTION OF THE GLOBAL PAIN MANAGEMENT MARKET BY
SEGMENT, 2012 (%/$ MILLIONS) 154
TABLE 56 DISTRIBUTION OF GLOBAL PAIN MANAGEMENT REVENUES BY REGION, 2012 (%/$
MILLIONS) 156
TABLE 57 SELECTED PAIN-MANAGEMENT DRUG PIPELINES 159
TABLE 58 U.S. PATENT EXPIRATION DATES FOR SELECT PAIN DRUGS 167
TABLE 59 FIRST TIME PRESCRIPTION GENERIC PAIN MANAGEMENT AND APPROVALS,
JANUARY 2004-OCTOBER 2012 169



LIST OF FIGURES

SUMMARY FIGURE GLOBAL PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES
MARKET, 2012 AND 2017 ($ MILLIONS) 7
FIGURE 1 PAIN-MANAGEMENT TECHNIQUES 15
FIGURE 2 ESTIMATED GLOBAL POPULATION BY SELECTED AGE GROUP AND SELECTED
YEARS, 2000-2030 (MILLIONS) 21
FIGURE 3 GLOBAL POPULATION BY SELECTED COUNTRY, 2010 AND PROJECTED 2015
(MILLIONS) 22
FIGURE 4 GLOBAL LIFE EXPECTANCY AT BIRTH BY SELECTED COUNTRY, 1980 AND 2010
(YEARS) 24
FIGURE 5 GLOBAL CANCER DEATHS BY TYPE, 2008 (THOUSANDS) 25
FIGURE 6 SEVERE HEADACHE OR MIGRAINE, LOW BACK PAIN, AND NECK PAIN AMONG
ADULTS 18 YEARS OF AGE AND OVER*, 2005-2009 (%) 27
FIGURE 7 ESTIMATED* PREVALENCE/INCIDENCE OF CONDITIONS AFFECTING THE
WORLDWIDE ORTHOPEDIC INDUSTRY, AVERAGE FIGURE 2008-2010 31
FIGURE 8 CAUSES OF CANCER PAIN 32
FIGURE 9 ADULT PREVALENCE RATE, 2011 (%) 36
FIGURE 10 BURN PAIN MANAGEMENT APPROACH 40
FIGURE 11 BIRTH RATES AND BIRTHS BY COUNTRY, 2010 ESTIMATES 42
FIGURE 12 PAIN BY SELECTED CATEGORY AND GENDER IN THE 18+ U.S. POPULATION*
(THOUSANDS) 47
FIGURE 13 TOTAL NUMBER OF ABUSE TREATMENT FACILITIES, 2000-2010 56
FIGURE 14 TOTAL NUMBER OF ABUSE TREATMENT CLIENTS, 2000-2010 57
FIGURE 15 PHYSICIANS PER 1,000 POPULATION BY COUNTRY, 2010* 75
FIGURE 16 NUMBER OF PHYSICIANS PER 100,000 RESIDENT POPULATION, UNITED STATES
2009 76
FIGURE 17 HOSPITAL USAGE STATISTICS (DAYS) 84
FIGURE 18 UNITED STATES: ADULTS 18 YEARS AND OVER WHO USED COMPLEMENTARY
AND ALTERNATIVE MEDICINE (CAM) IN THE PAST 12 MONTHS BY TYPE AND THERAPY,
2002-2012 (THOUSANDS OF PEOPLE)
125
FIGURE 19 TOTAL HOSPICE PATIENTS SERVED BY YEAR, 2006-2010 (TOTAL PATIENTS
SERVED, ESTIMATE) 128
FIGURE 20 TOTAL HOSPICE PATIENTS BY GENDER, 2009 AND 2010 (% OF TOTAL) 129
FIGURE 21 TOTAL HOSPICE PATIENTS BY AGE, 2009 AND 2010 (% OF TOTAL) 130
FIGURE 22 TOTAL HOSPICE PATIENTS BY PRIMARY DIAGNOSIS, 2009 AND 2010 (% OF TOTAL) 131
FIGURE 23 GLOBAL PRESCRIPTION PAIN MANAGEMENT PHARMACEUTICALS MARKET AT
MANUFACTURERS' SALES LEVELS, 2008-2017 ($ MILLIONS) 139
FIGURE 24 PRESCRIPTION NARCOTIC AND NON-NARCOTIC MANUFACTURER MARKET
SHARE BY REVENUE, 2012 ($ MILLIONS) 142
FIGURE 25 PRESCRIPTION ANTI-MIGRAINE DRUG MANUFACTURER MARKET SHARE BY
REVENUE, 2012 (%) 144
FIGURE 26 PRESCRIPTION ANESTHETIC MANUFACTURER MARKET SHARE BY REVENUE,
2012 (%) 145
FIGURE 27 GLOBAL PAIN MANAGEMENT DEVICES MARKET BY PRODUCT TYPE, 2008-2017 ($
MILLIONS) 148
FIGURE 28 GLOBAL NEUROMUSCULAR STIMULATOR/TENS—ELECTROTHERAPY
DEVICES—MANUFACTURER MARKET SHARE, 2012 (%) 150
FIGURE 29 GLOBAL SPINAL CORD STIMULATOR MANUFACTURER MARKET SHARE, 2012 (%) 151
FIGURE 30 PAIN MANAGEMENT PHARMACEUTICALS AND DEVICES MARKET BY REVENUE,
2008-2017 ($ MILLIONS) 153
FIGURE 31 PERCENT DISTRIBUTION OF THE GLOBAL PAIN MANAGEMENT MARKET BY
SEGMENT, 2012 (%) 154
FIGURE 32 PERCENTAGE DISTRIBUTION OF GLOBAL PAIN MANAGEMENT SHARES BY
REGION, 2012 (%) 156