Back in the early 1980s, I had chymopapain treatments for a herniated disc. It seemed to do the trick. I haven't had any trouble since then. Now my daughter has some back pain. When I asked around, there's no one doing this treatment any more. What happened?

Chymopapain was a treatment used to dissolve the herniated disc with an injection of enzymes. This type of treatment is called chemonucleolysis. It was used in the early 1970s but was taken off the market because of safety issues.

It was re-released by the Food and Drug Administration (FDA) in the early 1980s. Since that time, its use has fallen out of favor due to other more updated treatment methods.

This decision may have been premature. A recent historical review of the records showed that chymopapain is less invasive than surgery and may work better. After 40 years of collecting data, it looks like this type of treatment works better than a placebo and the results last 10 years or more.

It has been suggested that chemonucleolysis should be used as the next step after conservative care. It is a minimally invasive procedure. And it may be able to prevent patients from having open surgery.

On the other hand, since more patients having chemonucleolysis ended up having surgery anyway, it may make more sense to just have a discectomy (disc removal) in the first place. With the new, advanced surgical methods for disc removal, it's unlikely chymopapain will ever be an option again.

J. N. Alastair Gibson, MD, FRCS, and Gordon Waddell, DSc, MD, FRCS. Surgical Interventions for Lumbar Disc Prolapse. In Spine. July 15, 2007. Vol. 32. No. 16. Pp. 1735-1747.

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