Stakeholder Insight: Orthopedic Postoperative Pain - Old Habits Hurt Market Potential

Published by: Datamonitor

Published: Dec. 21, 2005 - 148 Pages

Table of Contents

CHAPTER 1 EXECUTIVE SUMMARY

Scope of the analysis

Datamonitor insight into the orthopedic postoperative pain market

Key metrics

CHAPTER 2 INTRODUCTION

Coverage of the Stakeholder Insight Survey

Section 1 - Epidemiology

Section 2 - Treatment trends for postoperative pain

Section 3 - Involvement of the varying healthcare professionals

Section 4 - Utilization of diagnostic tools

Section 5 - Preferred treatment options upon discharge

Section 6 - Pipeline drug therapies

CHAPTER 3 COUNTRY TREATMENT TREES

Similar treatments for mild and moderate pain

Morphine popularity varies by country

Implications for the pharmaceutical industry

US treatment of mild, moderate and severe postoperative pain

Japan’s treatment of mild, moderate and severe postoperative pain

France’s treatment of mild, moderate and severe postoperative pain

Germany’s treatment of mild, moderate and severe postoperative pain

Italy’s treatment of mild, moderate and severe postoperative pain

Spain’s treatment of mild, moderate and severe postoperative pain

UK treatment of mild, moderate and severe postoperative pain

CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION

Postoperative pain definitions and classification

What is postoperative pain?

Under-treatment of postoperative pain

Current management trends

Epidemiology of orthopedic postoperative pain

US

Japan

Europe

France

Germany

Italy

Spain

UK

Key patient segmentations

Surgery type by age

Gender difference in prevalence

CHAPTER 5 STAKEHOLDERS IN ASSESSING AND TREATING POSTOPERATIVE PAIN

Pre-surgery pain assessment is dominated by surgeons across all markets

Post-surgery pain assessment is also governed by surgeons

Surgeons play cardinal role in the initiation of post-surgery pain treatment except in the German market

Surgeons continue to manage postoperative pain relief after initiation

Japan and Germany deviating from the norm in respect to pain treatment following discharge

Country differentiations of the treating healthcare professional

Management and referral of patients

Surgeons involvement decreases significantly from 12 hours post-surgery

Healthcare provider receiving and making referrals in first two hours post-surgery

Surgeons in the first two hours

Anesthetists in the first two hours

Healthcare providers receiving and making referrals in the two- to 12-hour period following surgery

Surgeons in the two- to 12-hour time period post-surgery

Anesthetists in the two- to 12-hour time period post-surgery

Healthcare providers receiving and making referrals in the 12-24 hour period following surgery

Surgeons role in 12-24 hour period

Anesthetist role in the 12-24 hour period

Healthcare providers receiving and making referrals during the one- to five-day period post-surgery

Surgeons and anesthetists role in the one- to five-day period following surgery

CHAPTER 6 DIAGNOSIS AND PAIN ASSESSMENT

Patient management guidelines

American Society of Anesthesiologists (ASA)

The Agency for Healthcare Research and Quality (AHRQ)

Department of Defense, Veterans Health Administration (VHA) - The management of postoperative pain

Opioids are considered safe and effective

Acetaminophen and NSAIDs not recommended as sole agent for pain after major surgery

PROSPECT guidelines - European society of anesthesiologists & European society of regional anesthesiology and pain

ASA guidelines are the most widely known

Pain management planning and advice

Advice from anesthetists and surgeons

Commencing pain management programs

Presentation and assessment of pain

The vast majority of patients receive pain assessment regularly during the hours and days following surgery

Market analysis for pain assessment in first two hours post-surgery

Surgeons and anesthetists share in pain assessment during the first two hours following surgery

The role of ward physicians increases in pain assessment during the two to 12 hours following surgery

Nurses become more involved in pain assessment during the 12-24 hours following surgery

No change in pattern of assessing physician is seen after 24 hours

Presentation and diagnostic tools for pain assessment

Numerous pain scales are available to aid assessment

Discussion with patient

Visual Analogue Scale (VAS)

Faces Pain Rating Scale (FPRS)

Verbal Descriptive Scale (VDS)

Numerical Rating Scale (NRS)

Edmonton Symptom Assessment Scale (ESAS)

Objective Pain Score (OPS)

Brief Pain Inventory (BPI)

Discussion, not a single diagnostic tool dominates assessment

The most favored diagnostic tool in pain measurement

Differentiating between the different degrees of pain

Level of pain in the first two hours

Level of pain reported during the later periods

CHAPTER 7 TREATMENT TRENDS

Early pain treatment prevents later suffering for patients

Pharmacological versus non-pharmacological treatments

Pharmacological therapy is the foundation of treatment

Non-pharmacological methods of pain treatment

Transcutaneous electrical nerve stimulation (TENS)

Cold/heat

Exercise

Positioning

Immobilization/rest

Massage

Acupuncture

Other

Pharmacological treatment for postoperative pain

Treatment of mild and moderate postoperative pain is dominated by NSAIDs

The use of NSAIDs and other non-opioid analgesics for postoperative pain treatment

Acetaminophen is most popular first-line product to treat mild pain

Naproxen is most popular first-line product to treat moderate pain

Diclofenac second most stated drug for mild postoperative pain relief

Piroxicam in top three for use in moderate postoperative pain

Ibuprofen fourth most frequent first choice for both mild and moderate postoperative pain

Ketoprofen fifth most frequent first choice for both mild and moderate postoperative pain

Treatment of severe postoperative pain sees increase in opioid use

The use of opioids for postoperative pain treatment

Tramadol is respondents’ most popular choice for the treatment of severe postoperative pain

Morphine similar in popularity to tramadol for severe postoperative pain

Oxycodone third most frequent first choice for severe postoperative pain

Fentanyl fourth most frequent first choice for severe postoperative pain

Codeine fifth most frequent first choice for severe postoperative pain

Progression to a second-line therapy

Patients progress to second-line therapy up to five days following surgery

Progression on to third-line therapy

Patients on Patient Controlled Analgesia (PCA)

Inadequately treated pain affects all severities and may become an issue at discharge

Half of postoperative pain patients receive drug therapy upon final discharge from hospital

Treatment at hospital discharge is not known by hospital practitioners for milder cases

Duration of postoperative pain is generally less than five days

CHAPTER 8 UNMET NEEDS AND FUTURE THERAPIES

Treatment attributes

No single therapy addresses the key attributes

Physician assessment of changes in the market

Complications with treatment

New product development for postoperative pain

Bicifadine (SR)

ALGRX-4975

Morphine-6-glucuronide

APF-112

ORG-41793/DPI-3290

Lidocaine patch

Morphine (intranasal)

REN-213/nalbuphine + naloxone

Fentanyl (transdermal spray)

Dyloject (injectable diclofenac)

APPENDIX A: BIBLIOGRAPHY

Bibliography

APPENDIX B

Epidemiology calculation methodology

Physician research methodology

Physician sample breakdown

Contributing experts

APPENDIX C

The survey questionnaire

Treating healthcare professional

Pharmacological vs. non-pharmacological treatments

Non-pharmacological

Pharmacological therapy

Inadequately treated pain

Complications

Guidelines

Unmet needs

Pipeline products

Disclaimer

Abstract

Introduction
Postoperative pain can be caused by many different surgical procedures, each involving a variety of complications and physician specialties. Pain is a subjective experience for patients and it would seem that prescribing is driven by physicians' subjective preferences. Patients frequently have to suffer with their pain and request treatment before medication is initiated.

Scope
Current and future treatment regimens for post-operative pain following orthopedic surgery, based on a survey of 180 surgeons and anesthetists
Clarification of the nature of orthopedic postoperative pain and how it is managed including therapies used, prevalence rates and comorbidity factors
Identification of the types of healthcare professional involved in the treatment of postoperative pain, and their adherence to treatment guidelines
Review of current awareness among prescribers of drug therapies in the postoperative pain pipeline, with recommendations for promoting greater use
Highlights
No consistent trend is seen in therapy choice either across or sometimes even within countries. Although international guidelines exist, there seems to be little implementation. To help to secure a strong position, manufacturers will need to build the profile of existing guidelines with prescribers in addition to promoting their treatments.

Prescription of opioids in mild to moderate orthopedic postoperative pain may be restricted by the physician's perception of opioids as being less well tolerated and by the patient and prescriber's concern over the potential for abuse. To dispel these concerns companies need to ensure that safety is communicated alongside improved efficacy.

It is not currently standard practice within the market to prophylactically prescribe analgesia for the prevention of postoperative pain. Working with international opinion leaders and pain management groups for adoption of such an approach will both enhance the market potential and improve patients' recovery.

Reasons to Purchase
Identify the roles that surgeons, anesthetists and other physicians play in managing postoperative pain
Understand the dominance that NSAIDs and other non-opioid analgesics have in mild and moderate postoperative pain
Identify suitable positioning for pipeline drugs against current opioid market leaders in severe postoperative pain


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