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Chymopapain (Injection route)

Chymopapain is injected directly into a herniated ("slipped'') disk in the spine to dissolve part of the disk and relieve the pain and other problems caused by the disk pressing on a nerve. Before you receive chymopapain, you will be given an anesthetic (either a general anesthetic to put you to sleep or a local anesthetic).

What works?

Learn more about the effects of these drugs. The most reliable research is summed up for you in our featured article.

Very rarely, use of chymopapain may cause serious side effects, including paralysis of the legs or death. Another dangerous side effect of chymopapain injection is a severe allergic reaction called anaphylaxis… Read more
Brand names include
Drug classes About this
Gastrointestinal Agent, Proteolytic Enzyme

What works? Research summarized

Evidence reviews

Injection therapy and denervation procedures for chronic low-back pain: a systematic review

Injection therapy and denervation procedures are commonly used in the management of chronic low-back pain (LBP) despite uncertainty regarding their effectiveness and safety. To provide an evaluation of the current evidence associated with the use of these procedures, a systematic review was performed. Existing systematic reviews were screened, and the Cochrane Back Review Group trial register was searched for randomized controlled trials (RCTs) fulfilling the inclusion criteria. Studies were included if they recruited adults with chronic LBP, evaluated the use of injection therapy or denervation procedures and measured at least one clinically relevant outcome (such as pain or functional status). Two review authors independently assessed studies for eligibility and risk of bias (RoB). A meta-analysis was performed with clinically homogeneous studies, and the GRADE approach was used to determine the quality of evidence. In total, 27 RCTs were included, 14 on injection therapy and 13 on denervation procedures. 18 (66%) of the studies were determined to have a low RoB. Because of clinical heterogeneity, only two comparisons could be pooled. Overall, there is only low to very low quality evidence to support the use of injection therapy and denervation procedures over placebo or other treatments for patients with chronic LBP. However, it cannot be ruled out that in carefully selected patients, some injection therapy or denervation procedures may be of benefit.

Chemonucleolysis in lumbar disc herniation: a meta-analysis

This review concluded that chemonucleolysis with chymopapain was superior to placebo and as effective as collagenase, but heterogeneity between studies in the comparison with surgery made interpretation of the summary measure difficult. Given the small number of studies included, the potential for missed studies and the apparent publication bias, the conclusions of the review should be interpreted with some caution.

The Clinical Effectiveness and Cost-Effectiveness of Management Strategies for Sciatica: Systematic Review and Economic Model

Sciatica is a symptom characterised by well-localised leg pain with a sharp, shooting or burning quality that radiates down the back of the leg and normally to the foot or ankle. It is often associated with numbness or altered sensation in the leg.

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Summaries for consumers

The effects of surgical treatments for individuals with 'slipped' lumbar discs

Prolapsed lumbar discs ('slipped disc', 'herniated disc') account for less than five percent of all low‐back problems, but are the most common cause of nerve root pain ('sciatica'). Ninety percent of acute attacks of sciatica settle with non‐surgical management. Surgical options are usually considered for more rapid relief in the minority of patients whose recovery is unacceptably slow.

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