New Approaches to Neuropathic Pain

In some ways, neuropathic pain seems an odd choice of focus for a small start-up. It comes in many forms and its mechanisms are poorly understood. Moreover, the size and strength of those with stakes in the pain market might be another reason for emerging companies to steer clear. Fortunately, they're not. The unmet need is huge: Only one in two patients actually get some relief from existing drugs, in part because their mechanisms of action are fairly generalized. There remains plenty to be done in identifying and understanding the precise mechanisms behind the various flavors of neuropathic pain. For those whocan figure out new approaches to pain or new uses in pain for failed or overlooked compounds -- the companies profiled in this issue are doing both -- there's a big reward at the end: Sales of neuropathic pain therapies in the seven major pharmaceutical markets reached nearly $5 billion in 2007.

In some ways, neuropathic pain would seem an odd choice of focus for a small start-up. Neuropathic pain—that is to say, pain arising from a dysfunction of the nervous system itself rather than, for instance, from a burn or a broken limb—is most often associated with another disorder, which can vary widely in nature, from diabetes or HIV to cancer, multiple sclerosis, herpes and some kinds of stroke. A few conditions, such as fibromyalgia, are classified primarily by the presence of widespread pain.

The nature of pain as an effect most often linked to other conditions makes it hard to reliably pinpoint the...

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