Learn about Molecules in Chronic Pain

Dear colleagues,

Chronic pain syndromes are a heterogeneous group of diseases with numerous different pathomechanisms. About 50% and more of patients older than 80 years suffer from chronic pain with a reduced quality of life and increased mortality. A silver tsunami of aging societies will thus challenge both the clinicians and other healthcare practitioners in the upcoming 10 to 20 years. Despite of this circumstance medical regimens are limited and include NSAIDs, opioids and some other compounds. While intermittent NSAID use may be safe and effective, chronic NSAID use is associated with increased risks of comorbid conditions. The opioid crisis in the United States has clearly shown that these regimens should be used with extreme caution. Similar to degenerative chronic pain syndromes, inflammatory rheumatic diseases also share comparable features such as pain, increased mortality and reduced quality of life. In contrast to chronic pain syndromes, the prevalence of inflammatory rheumatic diseases is estimated to be about 1% of the total population in Europe. In the past 20 years, the advent of novel treatment strategies with monoclonal antibodies and more lately small molecules has revolutionized this area of rheumatology. A growing number of thus far at least 10 different target molecules such as anti-TNFs, rituximab, anti-IL-6s or JAK inhibitors are now available and have shown impressive efficacies in rheumatoid and psoriatic arthritis, vasculitides, or collagen diseases. In contrast, chronic pain syndromes with a prevalence of about 50% of the general population in Europe have been left behind, and only inhibitors of calcitonin gene-related peptide (CGRP) are approved for migraine thus far.

Pain and inflammation are tightly connected, and this is called neurogenic inflammation. Several key molecules are involved such as nerve growth factor (NGF), substance P, CGRP or glutamate. NGF appears to be a key player in chronic pain because it upregulates several downstream molecules. A set of several different anti-NGFs have been studied for a decade and are efficacious in chronic pain. However, rare and currently not well-understood adverse events such as rapidly progressive OA have delayed the approval of NGFi thus far.

On December 4, 2020 the first international meeting titled “Pain and Neurogenic Inflammation in Clinical Medicine 2020” took place in Lausanne, Switzerland. The scope of this meeting was to outline and discuss important aspects of chronic pain with regard to patient care, molecular mechanisms, and clinical science. Abstracts of each presentation are available for registered participants.

The second follow-up meeting is scheduled for December 2, 2022 and will more closely focus on individual target molecules in chronic pain. Similar to inflammatory rheumatic diseases different regulators may exist in chronic pain syndromes for targeted treatment strategies. These molecules include candidates such as NGF, CGRP, substance P, BDNF, cannabinoids, glutamate, or topical NSAIDs. The objective of this meeting is thus to serve as a platform for an open discussion and a scientific exchange to develop novel ideas. 

We would be pleased to welcome you in person or as an online participant.

Kind regards,

Matthias Seidel