Disease - Chymopapain

Chymopapain [9001 -90-6] derived from the latex of the papaya tree, produces improvement in lower back pain and sciatica in the majority (75%) of recipients (185—189) when injected into the lumbar intervertebral disks of patients suffering from herniated disk (the nucleus pulposus). This treatment degrades the proteoglycans of the diseased nucleus pulposus, resulting in shrinkage of the disk and reduction of pressure on the nerve roots (190). 

One important problem in determining efficacy of treatment seems to be the choice of the type of control. While in most cases the same volume of saline is injected into the intervertebral disk as a control 96], little or no rf ia are available that compare the effect of chymopapain treatment with the natural history of the disease [97]. This problem was discussed in an editorial in the Lancet in 1986 [98]. However, a number of studies have been published that compare chemonucleolysis with traditional surgical disc removal [99-1021. These studies indicate that surgical disc removal has an equal or slightly better overall success rate than chemonucleolysis. It has been argued that if chymopapain treatment fails, subsequent surgery may be less successful, especially if the operation Is delayed [103], but recent results indicate that this is not the case [104],... 

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