Disease Modification Therapies for Neuropathic Pain: Focus on High-concentration Capsaicin Patch

While symptom relief is the goal of most current treatments for neuropathic pain, and their mechanisms related to pain pathophysiology, this Master Class will introduce and discuss the novel concept of disease-modification for neuropathic pain.  
As an introduction, the disease-modifying potential of neurotrophic factors (e.g. rhNGF, HGF gene therapy), and immune therapies (e.g. IVIg), will first be discussed in general.   

The main focus is on recently published clinical studies using the Capsaicin 8% patch treatment, which showed regeneration and restoration of small sensory nerve fibres in serial skin biopsies; importantly, the neuropathic pain relief correlated with structural and functional recovery of small sensory nerve fibres.  These observations and the underlying mechanisms are described in patients with painful diabetic peripheral neuropathy (PDPN), chemotherapy-induced peripheral neuropathy (CIPN), and Non-freezing cold-injury (NFCI, “Trench Foot”).  Further, there is increasing evidence from large clinical trials for progressively improved efficacy when the patch application is repeated 2- to 3-monthly, both in patients with painful Diabetic and non-diabetic peripheral neuropathy; moreover, some patients who did not show a response to initial treatment reported good pain relief after two or more repeated applications.   Hence, clinical and tissue evidence supports the concept of Capsaicin 8% patch as an example of a Disease Modifying treatment.

Faculty:

• Praveen Anand
• Uma Anand
• Ralf Baron
• Marieke Niesters
• Rainer Freynhagen