Pharma companies may not have the financial resources and sales force capacity to directly address unmet educational needs,
but they can work with recognized organizations such as the American Pain Society for better outreach. By partnering with
medical associations and patient advocacy groups to encourage physicians to participate in continued medical education on
pain management, adhere to standardized guidelines, and leverage all available innovative treatment options to ensure optimal
treatment of pain, in the end, pharma companies stand to benefit from greater revenues.
Improper treatment results not only from doctors' lack of education, but also from patients who often contribute to their
own undertreatment of pain. Unfortunately, patients often hold several misconceptions about pain and relevant treatments
For example, many patients refuse opioid therapy because they are concerned about the potential for addiction. In a survey
conducted by the American Pain Society, more than 80 percent of patients list addiction as a main reason for precaution involving
narcotics use. Most commonly, patients confuse "tolerance" with "addiction." The need for an increased dose is a physiological
sign of tolerance—not addiction. Yet the fear of becoming "hooked" is a strong deterrent against prescription pain management
among many patients, especially the elderly—and some immigrants from countries such as China, whose cultures typically eschew
the notion of pain treatment—who have not been reached by pain-management education efforts.
In addition, patients with serious medical conditions generally expect to endure a certain level of pain. Cancer patients
often assume pain to be an inevitable adverse effect of their disease and related treatments such as chemotherapy. As a result,
many do not actively seek pharmacological relief from chronic symptoms.
Some doctors suffer similar misconceptions. In fact, some oncologists identify pain as a physical marker in the diagnosis
and prognosis of cancer. Changing degrees of pain, some physicians claim, inform them about the status of their patients'
cancer development. This misconception disregards patient comfort level and leads to preventable suffering and reduced quality
The pain-management market has many well-established brand and generic players, and strong competition is a substantial barrier
to entry for new companies. But those interested in entering it must target niche markets (such as abuse-resistant products)
or form strategic partnerships with current players.
Brand companies also face strong generic competition. In 2005, blockbuster drugs Duragesic and OxyContin will go off-patent
and face the possibility of losing significant market share. Currently, J&J's Duragesic is the only marketed pain therapeutic
to use the transdermal patch technology, although others are in the pipeline, including a generic from Endo and Alza's E-TRANS
OxyContin will also lose significant market share. Endo, the first generic manufacturer of extended-release oxycodone, will
enjoy 180 days of market exclusivity. Market erosion will increase after the exclusivity period ends and other generic players
enter the market. But the competition will not be as widespread as it is for other drugs because many generics companies simply
do not enter the narcotics market.
To combat generic competition, brand manufacturers must find ways to obtain patent extensions on their products through improved
formulations and expanded indications. But such strategies may not be effective if there is a lack of demand for their products
or resistance to their prices. For example, some pharmacies and hospitals do not carry newer or more expensive products with
sophisticated delivery systems, such as Actiq.
Companies with new, follow-on products seeking to win back market share lost to generics must find ways to speed the adoption
of their drugs, whether by providing compelling data from head-to-head studies or sustaining robust marketing and salesforce
The market for pain-management therapeutics is still maturing, with the release of next-generation products, alternative drug-delivery
systems, and even some new drug classes. Pain-management therapeutics may not be first-line treatments for cancer, diabetes,
and other serious diseases, but they should be—when appropriate—regular adjuvant therapies used to help patients improve their
quality of life and enhance physical and psychological endurance in coping with illness. But the industry must recognize that
expansion of the market, which in turn drives research and development, is contingent on continuing physician education and
positive patient response.