Expert Panel Calls for Best Practices and Practical Diagnostic Tools for Accurate Diagnosis and Management of Complex Pain

NEWARK, Calif., Sept. 16, 2015 /PRNewswire/ -- Leading health care professionals convened at PAINWeek 2015 in Las Vegas, NV, for an in-depth discussion on the challenges and best practices in accurately identifying a patient's pain, given more than 116 million people in the United States suffer from chronic pain.ⁱ The source of chronic pain often adds to the complexity of pain management and is affected by several factors including the fact that each patient's experience with pain is subjective. In an epidemiology study (N=85,014), 44 percent of patients suffered from a mix of neuropathic and nociceptive pain.ⁱⁱ Studies suggest chronic low back pain may have components of nociceptive and neuropathic pain and affects approximately 26 percent of adults in the United States.ⁱⁱⁱ

The complexity of pain management illustrates the critical importance for practitioners to understand and identify challenges in the diagnostic process, learn how to assess and diagnose patients suffering from a mix of neuropathic and nociceptive pain as well as the need to individualize each patient's treatment plan. The expert panel agreed that an inconsistency exists among health care providers surrounding the process of diagnosing different types of pain that is a mix of neuropathic and nociceptive, and that there is a need for further education, consensus guidelines and standardized diagnostic procedures to arm physicians with the appropriate tools that capture key information on a patient's pain during their appointments. The panel recognizes that primary care providers (PCPs) are on the frontlines of patient care and are often the first stop for patients during diagnosis and treatment for chronic pain. Therefore, PCPs need more appropriate resources to assess, diagnose and recommend treatment in the limited time they have with patients and in order to refer their patients to a pain specialist.

Panelists included Charles Argoff, MD, Professor of Neurology, Albany Medical College; Director, Comprehensive Pain Center, Albany Medical Center; Jeff Gudin, MD, Director, Pain Management and Palliative Care, Englewood Hospital and Medical Center; Srinivas Nalamachu, MD, President and Medical Director, International Clinical Research Institute Inc.; and Joseph Pergolizzi, MD, Adjunct Associate Professor, Department of Pharmacology, Temple University School of Medicine, all of whom have experienced a diverse range of patient cases that have evolved and expanded with changes to the field of pain management. The discussion was sponsored by Depomed, Inc.

"The discussion around pain diagnosis and management of patients suffering from pain that is a mix of neuropathic and nociceptive is evolving, but a multitude of factors such as comorbidities, caregivers' perceptions, fear of treatment and stigma can make finding an optimal treatment challenging," said Joseph Pergolizzi, MD, Adjunct Associate Professor, Department of Pharmacology, Temple University School of Medicine.

"It is important to approach each conversation with our patients with the right questions and individualize treatment that aligns the best treatment to the diagnosis, as this will help us manage our patients' pain effectively," said Srinivas Nalamachu, MD, President and Medical Director, International Clinical Research Institute Inc.

The panel's initial recommendations for best practices are:

• Develop a practical and standardized tool that quickly diagnoses patients and helps prioritize the discussion of different types of pain, in particular pain that is a mix of both neuropathic and nociceptive pain
• Convene a multi-disciplinary working group of experts to analyze current diagnostic tools and come to a consensus on guidelines which best help patients understand the complexities associated with different types of pain and
• Enhance communication with PCPs by providing access to pain specialists and resources in order to arm them with easy-to-use tools and increase education around the different types of pain

"As pain management specialists, we recognize that pain is complex, often a mix of both neuropathic and nociceptive pain, and the lack of understanding of the different types of pain has an impact on diagnosis and treatment," said Jeff Gudin, MD, Director, Pain Management and Pallative Care, Englewood Hospital and Medical Center.

Charles Argoff, MD, Professor of Neurology, Albany Medical College; Director, Comprehensive Pain Center, Albany Medical Center, added that, "Given that one third of the U.S. population suffers from chronic pain, which is greater than those suffering from cancer, heart disease and diabetes combined, we need practical resources, such as a diagnostic tool, that can better pinpoint the type of pain experienced by each patient to ultimately improve type of treatment, quality of life and cost of care."

Currently, general pain guidelines exist from leading organizations, including the American Pain Society and American Academy of Pain Medicine. However, the panel agreed that the pain management field benefits from refining current guidelines to incorporate more than one biological mechanism for pain, as well as information on the evolving therapeutic landscape which allows physicians to tailor treatment to these biological needs. Pain is caused by different pathophysiological mechanisms, including neuropathic, nociceptive and a mix of neuropathic and nociceptive mechanisms.^iv In the meantime, pain management specialists are encouraged to engage in dialogue with their patients to better understand and diagnose the type of pain they are experiencing, as well as share best practices and disseminate them to the pain management community.

About Chronic Pain
Pain, particularly chronic pain, can be a mix of nociceptive and neuropathic origin. Nociceptive, or somatic, pain is the common discomfort felt as a result of an injury. In contrast, neuropathic pain involves the nerve fibers being damaged, dysfunctional, or injured causing a feeling often described as dull or aching.^iv Studies suggest chronic low back pain may have components of both nociceptive and neuropathic pain. The aforementioned epidemiology study (N=85,014) found 44 percent of patients suffered from a mix of neuropathic and nociceptive pain, while a review of select studies of pain conditions that explored mixed pathophysiology of pain found 57 percent of chronic low back pain patients had a mix of both neuropathic and nociceptive pain.^v

The Institute of Medicine reports that chronic pain reduces quality of life and costs society as much as $635 billion a year in medical treatment and lost productivity.^iv

About Depomed
Depomed is a specialty pharmaceutical company that commercializes products for pain and neurology related disorders. Our NUCYNTA® franchise includes NUCYNTA® ER (tapentadol) extended release tablets indicated for the management of pain, including neuropathic pain associated with diabetic peripheral neuropathy (DPN), severe enough to require daily, around-the-clock, long-term opioid treatment, and NUCYNTA® (tapentadol), an immediate release version of tapentadol, for management of moderate to severe acute pain in adults. Gralise® (gabapentin) is a once-daily treatment approved for the management of postherpetic neuralgia. CAMBIA® (diclofenac potassium for oral solution) is a non-steroidal anti-inflammatory drug indicated for acute treatment of migraine attacks with or without aura in adults (18 years of age or older). Zipsor® (diclofenac potassium) Liquid Filled Capsules is a non-steroidal anti-inflammatory drug indicated for relief of mild to moderate acute pain in adults. Lazanda® (fentanyl) Nasal Spray is an intranasal fentanyl drug used to manage breakthrough pain in adults (18 years of age or older) who are already routinely taking other opioid pain medicines around-the-clock for cancer pain. Gralise, Nucynta ER and various partner product candidates are formulated with Depomed's proven, proprietary Acuform® drug delivery technology. Additional information about Depomed may be found at www.depomed.com.

Forward-Looking Statements
"Safe Harbor" Statement under the Private Securities Litigation Reform Act of 1995. The statements that are not historical facts contained in this release are forward-looking statements that involve risks and uncertainties including, but not limited to, those related to Depomed's prospects as a standalone business, Depomed's business strategy, expectations regarding Depomed's future financial results and the ability to create shareholder value, expectations regarding anticipated growth and the future contributions and potential of NUCYNTA, and other risks detailed in the company's Securities and Exchange Commission filings, including the company's Annual Report on Form 10-K for the year ended December 31, 2014 and its most recent Quarterly Report on Form 10-Q. The inclusion of forward-looking statements should not be regarded as a representation that any of the company's plans, objectives or expectations will be achieved. You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. The company undertakes no obligation to publicly release the result of any revisions to these forward-looking statements that may be made to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events.

Investor Contact:
Depomed, Inc.
Christopher Keenan
510-744-8000
[email protected]

SOURCE Depomed, Inc.

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