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Jul 01, 2019
Each year, approximately 3.6 million people in the United States complain of Lower back pain (LBP). Among all types of chronic pain, back pain has often been suggested to be the most frequent type and is considered the second most common neurologic disease and most physician visits can be attributed to it.
The lower back supports the weight of the whole body. Everyday mobile functions like bending, moving, walking, twisting, flexing, rotating the hips etc. are all facilitated by the muscles in the lower back. Nerves in the spinal column are responsible for sensation all over the lower body. And injury in ligaments, muscles, joints or discs results in acute lower back pain. The pain, if persists for more than three weeks, is referred to as Chronic lower back pain.
Chronic lower back pain is a lower back syndrome, which is a leading cause of health problems in developed and industrialized nations. People who suffer from CLBP, struggle with symptoms like back stiffness, decrease in movement of lower back and problems in standing straight. CLBP patients also develop arthritis (rheumatoid arthritis) due to extra wear and tear of the spinal cord from extraneous activities. Chronic lower back pain usually persists beyond normal healing time lasting from weeks to months. Possible causes of CLBP include scoliosis or kyphosis (curvature of the spine), herniated disc and piriformis syndrome, which is a pain disorder that involves the muscle (piriformis muscle) in the buttocks.
According to the existing literature, the chronic lower back pain prevalence is estimated to be around 15% in US adults. A study titled by Yoichi Iizuka et al., showed that the prevalence of Chronic Nonspecific Low Back Pain (CNSLBP) and chronic specific low back pain (CSLBP) was nearly 15% and 10%, respectively. Moreover, among the subjects with CLBP, the majority had CNSLBP. A review article, by Melissa Juniper et al., the chronic lower back prevalence in Italy was around 6%, and for the UK it ranged from 7-10%. The figures for French healthcare workers, however, was shockingly higher than the others ranging approximately from 17% to 43%. Studies revealed that CLBP prevalent population comprised more of women than men.
As per DelveInsight’s analysis, a higher percentage of chronic lower back pain diagnosed prevalence was observed for females, in comparison to males, in all the 7MM countries, except Japan, wherein males occupy a larger patient pool than females. Moreover, the total CLBP prevalent population of CLBP in the 7MM was observed to be 73,802,461 in 2017, which is expected to increase during the study period, i.e. 2017-2028. However, the total diagnosed prevalent population of CLBP in the 7MM was assessed to be 44,281,476 in 2017. The estimates show the highest chronic lower back pain diagnosed prevalence in the United States, with more than 20 million cases in 2017. Among the European 5 countries, the United Kingdom had the highest CLBP diagnosed prevalent population, followed by Germany and Franc with Spain having the lowest. Additionally, Japan was observed with 8,865,879 CLBP diagnosed prevalent cases in 2017.
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Chronic lower back pain therapeutic landscape includes conservative management and invasive treatments. The current CLBP conventional therapy comprises the use of non-steroidal-anti-inflammatory drugs (NSAIDs), acetaminophen, muscle relaxants, or even a short course of opioid pain medication {Opioid analgesics (with or without paracetamol)}. They may help improve the pain in conjunction with non-pharmacological strategies, such as physical therapy. The chronic lower back treatment program also comprises of Nonpharmacologic therapies, which are effective in specific clinical situations. For effective CLBP treatment, maximum pain relief and minimum side effects, the active pharmaceutical ingredients are delivered to specific sites of inflammation, thus requiring novel drug delivery mechanisms in pain management.
Of the aforementioned CLBP therapies, NSAIDs are more effective at reducing gastrointestinal associated pain intensity in CLBP patients. Further, Acetaminophen (Paracetamol) and Benzodiazepines are also used to treat low back pain. However, NSAIDs, compared with Diflunisal (analgesics), may be more effective than paracetamol in treating CLBP, if we go by patient experience. Another Chronic lower back pain treatment drug, Tetrazepam (muscle relaxant) is also known to be more effective in reducing CLBP pain, but lack of evidence obstructs the researchers to say the same. Furthermore, Adjuvant analgesics, such as anticonvulsants and antidepressants, are prescribed to relieve pain in certain conditions. In addition to pharmacological treatment regimens, Fusion surgery, which has shown to be effective than standard therapy for improving pain in people with chronic non-radicular low back pain. However, if conservative therapy fails to provide symptomatic relief, other treatments such as epidural steroid injections, facet injections, and radiofrequency ablations, are recommended. Unfortunately, even these more invasive procedures have not been shown to decrease the need for subsequent surgeries in patients with chronic pain secondary to herniated lumbar intervertebral discs.
To conclude, a better and clear picture of CLBP pathogenesis will significantly improve the treatment regimens and development of novel therapies. However, there is still scope for further research to focus on the precise mechanisms underlying pathogenesis, highlighting the biomarkers of chronic lower back pain and optimizing characteristics of drugs as well.
Several companies like Braeburn Pharmaceuticals, Teva, Nektar Pharmaceuticals and many more have started working towards accelerating the CLBP therapy market. DelveInsight’s analysts estimate that the CLBP Therapeutic market is expected to experience a boost in the coming years owing to the already prescribed products along with the launch of distinctive CLBP emerging therapies in the coming years.
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