Pain Study in Total Knee Arthroplasty

This is a Phase 2, multi-center, randomized, double-blind, placebo-controlled, parallel
design study evaluating, in a pilot stage of the study, up to 3 ascending dose level cohorts
each evaluating a single dose of CA-008 vs. placebo injected/instilled during an elective
TKA. Up to 54 subjects will be randomized in the pilot stage. During the second stage of the
study, subjects will be randomized to one of either 2 or 3 CA-008 dose levels (to be
determined) or placebo.

Key Inclusion Criteria:

1. Plan to undergo an elective primary unilateral total knee arthroplasty (TKA or knee
replacement), without collateral procedure or additional surgeries.

2. Be a reasonably healthy adult aged 18 - 80 years old, inclusive, with a BMI ≤ 36 kg/m2
and American Society of Anesthesiology (ASA) physical Class 1, 2 or 3 at the time of
randomization.

3. Males and females must abstain from intercourse, use acceptable birth control methods
or be sterile or otherwise incapable of having children.

4. Be willing and able to sign the informed consent form (ICF)

5. Be willing and able to complete study procedures and pain scales and to communicate
meaningfully in English. Be able and willing to return for outpatient follow up visits
as required.

Key Exclusion Criteria:

1. In the opinion of the Investigator,

1. have a concurrent painful condition, other than pain in the knee to be replaced,
that may require pain treatment during the study period.

2. have active skin disease or other clinically significant abnormality at the
anticipated site of surgery that could interfere with the planned surgery.

2. Have a known allergy to chili peppers, capsaicin or the components of CA-008,
ropivacaine, ketorolac, acetaminophen, fentanyl, hydromorphone, morphine or oxycodone.

3. Have significant medical, neuropsychiatric or other condition.

4. The following are considered disallowed medications:

1. tolerant to opioids as defined

2. capsaicin-containing products or foods.

3. central nervous system active agent as an analgesic adjunct medication

4. antiarrhythmics except beta-blockers, digoxin, warfarin, lithium, or
aminoglycosides or other antibiotics for an infection

5. parenteral or oral corticosteroids.

6. antianginal, antihypertensive agent or diabetic regimen at a dose that has not
been stable for at least 30 days or which is not expected to remain stable while
participating in the study.

5. Have positive results on the alcohol breath/saliva test indicative of alcohol abuse or
urine drug screen indicative of illicit drug use at screening, and/or prior to
surgery.