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.

Pain Misconceptions 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.

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 of life.

Competitive Arena 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 fentanyl.

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 efforts.

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.