Health Care

Breaking Through Pain: New Targets and Opportunities

By: Phil Nadeau, Steve Scala, Joseph Thome, Tyler Van Buren, Rick Weissenstein, Erin McCallister

Apr. 17, 2025 - 5 minutes

Overview:

The market for pain relief is large; approximately 1 in 5 people globally suffer chronic pain, and there's a total addressable market (TAM) of more than US$12.4 billion for brand drugs in the U.S. alone.
More than 15 novel programs are currently in development with clinical data pending across acute, neuropathic and osteoarthritis conditions. Key opinion leaders (KOLs) find the targets sensible for pain.
Recent medical breakthroughs driving the sector include the first new non-opioids to treat acute pain in over two decades.
New Washington legislation may also incentivize the adoption of non-opioid alternatives.

The TD Cowen Insight

These novel mechanisms from top pharmaceutical companies provide reason for optimism, and policies in D.C. could help brand drugs gain traction over generic opioids, satisfying an unmet need in the pain market.

Driving Growth of Non-Opioid Market

We believe that the pain treatment landscape could represent a new and underappreciated opportunity for investors. After years of failed attempts to move away from opioid-based pain options, combined with the more recent concern about the opioid public health crises, our analyses of the acute and chronic pain pipeline provides reason for optimism.

Medical Breakthroughs

The approval of the first non-opioid to treat acute pain in more than two decades, a burgeoning pipeline of potential new drug candidates backed by sound scientific rationale and some early clinical proof of concept gives us confidence that the pain market could flourish over the coming decade.

A key linchpin to this scientific revolution of sorts, is whether clinicians will use them and whether payors will reimburse these newer options ahead of much cheaper, but more addictive, opioids. Our KOLs suggest that they will reach for the newer options so long as payors also put them on par (at the same formulary tier) as opioids. The price differential of the new drugs isn't to be taken lightly but put up against the cost of opioid addiction and abuse. It may be able to tip the scale.

Potential Legislation Changes

Legislation passed by Congress in 2022 could also start to help in 2025. Another bill has been proposed that could further incentivize the use of new non-opioid alternatives. We remain confident that non-opioid alternatives will be preferred – or at the very least not discouraged – by the new administration.

Overall, our research finds that physicians' expectations for the use of a non-opioid in acute pain implies penetration that is far greater than consensus (and our estimates), suggesting a desire among physicians to adopt non-opioid options that is much stronger than investors assume. This report also introduces a deep pain pipeline of potential new agents that we believe could be surprising (in a positive vein) for investors who may not be paying attention. The number of novel pain mechanisms in clinical development, and the potential that they could meaningfully change the pain treatment paradigm, would seem to be much greater than investors appreciate.

What Is Proprietary?

This multi-analyst report provides an in-depth look at the commercial outlook for the newest non-opioid pain medicine as well as a sweeping overview of the clinical pipeline and scientific rationale for the myriad targets under investigation. Our findings are supported by expansive Key Opinion Leader (KOL) diligence including discussions with seven scientists and clinicians, two regulatory experts and surveys of 25 physicians and 15 payors. Analyses of clinical pipelines, literature reviews and assessments of U.S. regulatory and legislative landscape buttress the report.

Billion-Dollar Growth Expected in Pain Management Category

We expect the demand for pain management products, branded and generics, to continue to grow due to the following:

favorable demographics,
increasing incidence of chronic pain conditions,
increasing physician recognition of the benefits of pain management, and
a steady stream of new pain products, including opioid alternatives recently approved and in late stages of development.

In addition to the first new drug in two decades, pipelines at pharma companies and some innovative biotech companies are starting to advance novel candidates with a range of mechanisms.

Our KOLs believe the novel targets make sense mechanistically though clinical efficacy and safety in patients need to bear out.

Nonetheless, the global pain market is sizeable, offering significant market opportunity if even one of these agents is successful. Globally, 1 in 5 people experience chronic pain. In the U.S. more than 17 million Americans experience high intensity chronic pain. For acute pain, it is estimated that there are approximately 1.5 billion painkilling days per year. Even if brand products priced at a nominal $8 per day were to penetrate just 20% of this heavily generic market, we estimate that the pain market for brand products could be at least $12.4 billion in the U.S. alone. In the near term, we project that the pain management category could grow from approximately $1.7 billion in 2023 to $4.1 billion worldwide by 2030.

What To Watch

Numerous early- and late-stage pain programs targeting novel mechanisms are expecting data and trial starts over the next 18-plus months. There are also a handful of policy and legislative milestones that are on our radar, including a scheduled May Food and Drug Administration (FDA) Advisory Committee meeting that could give us the first glimpse of the new administration's perspective on opioids and potentially non-opioid pain alternatives.

Subscribing clients can read the full report, Breaking Through Pain: New Targets & Opportunities - Ahead Of The Curve, on the TD One Portal

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Phil Nadeau, Ph.D.

Managing Director, Health Care – Biotechnology Research Analyst, TD Cowen

Phil Nadeau, Ph.D.
Managing Director, Health Care – Biotechnology Research Analyst, TD Cowen

Biography

Philip Nadeau is a managing director and senior research analyst on the biotechnology team at TD Cowen. He joined TD Cowen in 2000 and is responsible for covering approximately 25 large-, mid-, and small-cap biotechnology stocks. TD Cowen’s biotechnology team has consistently been among the top-ranked teams in the Greenwich Survey. Dr. Nadeau has been recognized in The Wall Street Journal’s “Best on the Street” rankings and in the Institutional Investor poll. His views on biotechnology topics are often quoted by national news services such as Reuters, Bloomberg and the Dow Jones newswires. Prior to joining TD Cowen, he was a research assistant at Children’s Hospital, Boston.

Dr. Nadeau has an SB/MEng in electrical engineering and computer science from MIT and a Ph.D. in Neurobiology from Harvard University.

Steve Scala, RPh, CFA

Managing Director, Health Care – Major Pharmaceuticals Research Analyst, TD Cowen

Steve Scala, RPh, CFA
Managing Director, Health Care – Major Pharmaceuticals Research Analyst, TD Cowen

Biography

Steve Scala is a senior research analyst with more than 30 years of experience following the pharmaceutical industry, including large-, mid- and small-cap companies. Prior to joining TD Cowen, Mr. Scala was a pharmacist at Tufts Medical Center in Boston. He received a BS in pharmacy from the University of Connecticut, an MS in pharmacy from Ohio State University, and an MBA from Bentley College. He is a CFA charterholder.

Joseph Thome, PhD

Managing Director, Health Care – Biotechnology Research Analyst, TD Cowen

Joseph Thome, PhD
Managing Director, Health Care – Biotechnology Research Analyst, TD Cowen

Biography

Joseph Thome is a managing director and senior research analyst on TD Cowen’s biotechnology team. Dr. Thome was selected as a “Rising Star in Equity Research” by Business Insider in 2021 and the TD Cowen biotechnology team has consistently been among the top-ranked teams in the Greenwich Survey.

Prior to joining TD Cowen in March 2016, Dr. Thome was an NIH pre-doctoral research fellow at Columbia University, studying the compartmentalization and maintenance of the human T cell immune response from infancy into adulthood. His research has been published in several prestigious journals including Cell and Nature Medicine.

Dr. Thome received a BA with high honors in chemistry and biochemistry from Oberlin College and a Ph.D. in microbiology and immunology from Columbia University, where he was granted the Dean’s Award for Excellence in Research.

Tyler Van Buren

Managing Director, Health Care – Biotechnology Research Analyst, TD Cowen

Tyler Van Buren
Managing Director, Health Care – Biotechnology Research Analyst, TD Cowen

Biography

Tyler Van Buren is a Managing Director and senior equity research analyst on the biotechnology team at TD Cowen.

Mr. Van Buren has a decade and a half of equity research experience and is responsible for providing analysis on large-, mid-, and small-cap biotechnology stocks. His views on biotechnology topics are often quoted by national news services such as Bloomberg, Endpoints News, Reuters, STAT, and the Wall Street Journal, and he has been featured as a guest on CNBC and Fox News.

Prior to rejoining TD Cowen, Mr. Van Buren was a Managing Director and senior biotechnology equity research analyst at Piper Sandler (previously Piper Jaffray) for over three years. Prior to Piper Sandler, Mr. Van Buren spent five years on the biopharma research team at TD Cowen. Previously, Van Buren was a founding member and Managing Director at LifeSci Advisors where he helped build the firm’s biotechnology research practice. Earlier in his career, he worked at Amylin Pharmaceuticals, Lithera Pharmaceuticals, the Sanford-Burnham Medical Research Institute, and the U.S. Department of Agriculture.

Mr. Van Buren earned a master’s degree in biology and a bachelor’s degree in biochemistry and cellular biology from the University of California, San Diego.
HCBiopharma

Rick Weissenstein

Managing Director, Washington Research Group - Health Care Services & Pharmaceutical Policy Analyst, TD Cowen

Rick Weissenstein
Managing Director, Washington Research Group - Health Care Services & Pharmaceutical Policy Analyst, TD Cowen

Biography

Rick Weissenstein joined TD Cowen Washington Research Group in August 2016 and covers health care services policy issues. TD Cowen Washington Research Group was recently named #1 in the Institutional Investor Washington Strategy category. The team has been consistently ranked among the top macro policy teams for the past decade. Previously he worked as a senior analyst at Guggenheim Securities, MF Global, Stanford Financial, and Schwab Soundview, where he was responsible for analyzing health care policy issues and emerging trends in the federal and state legislative, regulatory, and legal arenas and their implications for the health care industry.

He was formerly the Washington Bureau Chief for Modern Healthcare magazine, and a reporter for Advertising Age magazine. Mr. Weissenstein began his career as a Certified Public Accountant in the Chicago office of Ernst & Young. He earned a bachelor’s degree in accounting at Millikin University, and a master’s degree in journalism at the University of Illinois, Champaign-Urbana.

Material prepared by the TD Cowen Washington Research Group is intended as commentary on political, economic, or market conditions and is not intended as a research report as defined by applicable regulation.