Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

On the basis of the early results of the use of intradiscal injection of chymopapain in 15 patients with degenerative lumbar disc disease, the following statements are warranted: The injection can be beneficial in selected patients with lumbar disc disease. The relief of leg symptoms seems to be more striking than that of the accompanying low back symptoms although both are apparent. The exact mechanism by which pain is relieved is still obscure, but helpful information has been obtained from the early results of this investigation. The failure of chymopapain in carefully selected patients has resulted in only a brief time delay in operative intervention.
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PMID:The use of chymopapain in degenerative disc disease: a preliminary report. 544 94

In a follow-up study of a large group of patients who had been treated by chemonucleolysis, of those patients who had definite neurologic change in the form of reflex, sensory, or motor disturbance, 74 per cent had reverted to normalcy by the time of evaluation one year after injection. The most significant complication (anaphylaxis) was found in 1 per cent of our first 500 patients, but after we started using preoperative steroids along with other safeguards, we were able to control this complication. It is still something to be constantly on guard against. A mildly extruded nucleus pulposus is not a contraindication in chemonucleolysis. A sequestered one is. (table; see text) Patients who have had previous low back surgery have a lower percentage of satisfactory results than those who have not had previous surgery. Chemonucleolysis does not prejudice the chances of a good clinical result if a subsequent open surgical procedure is necessary. Preoperative psychological testing is a very effective predictor of end results in relation to pain relief from chemonucleolysis. Studies in our laboratory again confirm beyond a doubt that, in the dog, injection of very large amount of chymopapain in the epidural space of the lumbar spine has no effect on the subarachnoid contents, the dura, or the spinal nerves as they lie outside the dura and exit through the intervertebral foramina. The rare patient in whom there is a direct communication between the disc space and the subarachnoid space can be detected as the contrast medium is injected. If, by chance, chymopapain were inadvertently injected intrathecally, the maximum dose of that would be injected at any one level, 8 mg, would be well within the tolerable range in the human being.
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PMID:Chemonucleolysis in the treatment of lumbar disc disease. 634 6

Sixty patients with unilateral sciatica resulting from lumbar intervertebral disc herniation were entered into a double-blind study. All patients had failed to respond to conservative management, and the diagnosis had been confirmed by metrizamide myelography. Following a randomized schedule, 30 patients had intradiscal injections of chymopapain, and 30 patients had intradiscal injections of an equivalent volume of normal saline solution. Two years after the injection, 77% of patients treated with chymopapain were assessed as moderately improved, compared with 47% of saline-injected patients. Fifty-seven percent of the chymopapain group were free of pain, compared with 23% in the saline group. Based on the late results of this study, chymopapain is recommended for the treatment of sciatica from intervertebral disc herniation when conservative measures have failed and before disc fragment excision is considered.
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PMID:Chymopapain for the treatment of intervertebral disc herniation. The final report of a double-blind study. 639 44

Chemonucleolysis is a safe, relatively minor procedure which can be done with the patient under local anesthesia. If the procedure is confined to patients with sciatica resulting from a herniated intervertebral disk, and patients with non-organic spinal pain, spinal stenosis and poor response to previous surgery are excluded, good results can be anticipated. It is important that the technique include proper placement of the needle and injection of adequate amounts of chymopapain into a disk space which is free of other materials. Chemonucleolysis is a good procedure to bridge the wide gulf between standard conservative treatment and surgery.
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PMID:Chemonucleolysis: experience with 2000 cases. 698 36

Chemonucleolysis is the nonoperative chemical removal of displaced lumbar disc material. The enzyme chymopapain, which has a wide margin of safety between its effective therapeutic and toxic doses, is effective in the management of sciatica due to a herniated intervertebral disc. The patient will have leg pain as the dominant symptom and a 50% reduction in straight-leg raising with or without bowstring discomfort and crossover pain. Neurologic symptoms and signs are usual, as are abnormal results of contrast studies, which will verify the level of involvement. In 220 randomly selected patients who met criteria for the diagnosis of sciatica due to a herniated intervertebral disc and did not have psychogenic or nonorganic spinal pain, a spinal stenosis or a history of a previous, unsuccessful operation to relieve the sciatica, chemonucleolysis had a success rate of 80%. The only complications were a severe anaphylactic reaction in two patients and lesser, delayed reactions in five others. All of the reactions were successfully treated. Of the 45 patients in whom chemonucleolysis was unsuccessful, 38 underwent a laminectomy. In 3 of the 38 the results of chemonucleolysis were initially good, but later the disc herniation recurred; thus, the long-term treatment failure rate was 1.4%.
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PMID:Chemonucleolysis for relief of sciatica due to a herniated intervertebral disc. 701 30

The symptom of back pain may be the result of many different pathologies. As such, patients with back pain require careful assessment to determine whether the cause is from the spine or other systems. For acute mechanical back pain, treatment is often symptomatic. Symptomatic treatment may include analgesics, anti-inflammatories and/or muscle relaxants. Patients may also need hypnotics in the short term to help them sleep at night. However, drug therapy should be reduced and stopped as soon as possible. Furthermore, too much bedrest may be counterproductive. Paracetamol (acetaminophen) is the standard treatment for transient back pain. More severe pain may require the addition of an opioid, such as codeine or dextropropoxyphene. Morphine and pethidine (meperidine) may be necessary in patients with back pain due to neoplastic disease or osteoporotic fracture. However, the opioid analgesics are associated with dependence, tolerance and adverse effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic efficacy comparable with paracetamol. Individual patients respond differently to different NSAIDs, and several agents may have to be tried. Long term therapy with NSAIDs is necessary in diseases with an inflammatory component such as ankylosing spondylitis. Calcitonin reduces bone resorption and bone blood flow, and has been suggested to have central analgesic effects. As such, it has been used successfully in patients with Paget's disease, osteolytic bone disease and osteoporosis. Bisphosphonates also inhibit osteoclastic bone resorption and may be useful in Paget's disease, osteolytic metastases and osteoporotic fractures. Other drugs which may be useful in relieving back pain associated with specific circumstances include the tricyclic antidepressants, anxiolytics, antiepileptic agents, corticosteroids, colchicine and chymopapain.
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PMID:Pharmacological management of back pain syndromes. 752 24

The combination of low-dose chemonucleolysis with 500 IU chymopapain followed by an automated percutaneous nucleotomy of the cervical spine is a new procedure. A follow-up of at least 1 year of the first 22 patients showed in 19 patients good or excellent results. In one patient a fair result was obtained, and in two patients the symptoms were unchanged; one of these patients subsequently underwent diskectomy and anterior cervical spine fusion. Preoperatively, all patients showed a clear cervical disk herniation with predominantly radicular pain. The procedure has been performed so far in approximately 100 patients. No intra- or postoperative complications have been noted.
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PMID:Low-dose chemonucleolysis combined with percutaneous nucleotomy in herniated cervical disks. 767 Feb 15

Postoperative low-back pain and spasm are the main drawbacks of chymopapain chemonucleolysis. To investigate if low-dose chymopapain could reduce this adverse reaction, without modifying the efficacy, 118 patients with persistent low-back and radicular pain due to a lumbar disc herniation underwent chemonucleolysis. 60 patients were randomly selected to receive 2 mL of standard-dose chymopapain (4,000 units) and 58 to receive 2 mL of low dose (2,000 units). The clinical outcome was assessed on study days 1, 30, and 60, and after 1 year by physicians who were unaware of the treatment, and on the basis of the patients' self evaluation. At day 60, Chemonucleolysis was rated as successful in 81% of the cases by the investigator and in 80% by the patient's self assessment. The percentage of good results was remarkably similar in the two treatment groups and this finding was confirmed after 1 year. There was some evidence that the low-dose treatment resulted in less frequent postoperative back pain but the difference was not statistically significant. Moreover, a comparable incidence of acute low-back pain and spasm was observed in the two treatment groups. Low-dose chemonucleolysis appears to be as effective as the standard dose, but the use of 2,000 units does not significantly lower the postoperative back pain.
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PMID:A randomized, double-blind study to compare low-dose with standard-dose chymopapain in the treatment of herniated lumbar intervertebral discs. 843 22

For many years now percutaneous techniques have proved effective in the curative treatment of lumbar disc herniation, mostly in young subjects. This technique, however, is seldom indicated, let alone performed, in the cervical spine for a variety of reasons: a) the neck contains several closely arranged structures such as the vasculo-nervous bundles, the airway-digestive tract and the cervical spine around the spinal cord; b) the disc is approached by the anterior route, in contrast with the lumbo-sacral spine where the approach is posterolateral; c) the manufacturers insist on restrictions in the use of chymopapain in view of the potential risk of spinal cord damage, either by possible breaks in the meninges of by accidental diffusion of the enzyme into perimedullary epidural structures which support a particularly developed venous plexus; d) legal protection may be denied to operators who perform cervical chemonucleolysis, since the product has not yet been officially authorized, in France and perhaps elsewhere*, for treatment of cervical disc herniation. Several years of experience in the practice of cervical nucleolysis have convinced the authors that this method is remarkably effective and can be used in the treatment of cervicobrachial neuralgia (CBN) occurring in young subjects. Radiculalgia is essentially due to a disc fragment being positioned within the vertebral canal or a foramen, thereby compressing the nerve roots. During several years microsurgery of the disc has been effective in the treatment of refractory radiculalgia, and to compete with this procedure familiar to neurosurgeons cervical nucleolysis must convincingly demonstrate that its therapeutic value is at least as good as that of surgery. Finally, the vast majority of cervical disc herniations is made up of free disc fragments located within the meshes of the posterior longitudinal ligament of the spine (transligamentous fragment). Cervical nucleolysis was introduced in France by Bonafe and Lazorthes made enthusiastic by their first studies, and the idea of this procedure, developed by a radio-neurosurgical team, has gradually been gaining ground. The decision to intervene is made when the radiculalgia is recurrent or resistant to a well-conducted medical treatment of several weeks duration. Therefore all disc herniations that would have been treated surgically can be treated by injection of an enzyme. This point is very important, and in fact the well-codified and effective surgical procedure has progressively been abandoned by the operators, in view of the simplicity of nucleolysis and the rapid pain relief it procures.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cervical nucleolysis: indications, technique, results. 190 patients. 849 75

If correct indications and rigorous technique are applied, nucleolysis with chymopapain can be an effective cure for herniated nucleus pulposus in patients who do not respond to adequate medical treatment. Pain relief is obtained in approximately 75% of the patients. In case of failure, secondary surgery may be proposed with a success rate similar to primary surgery. The risk of complications is lower than for surgery. Initial satisfactory results are usually maintained at long term. The main inconveniences include a possible painful reaction in 30-40% of the patients and in certain cases progressives rather than rapid pain relief. Cost analysis shows a 40% gain over surgery. After 20 years of experience, chemonucleolysis for herniated nucleus pulposus has been shown to be an effective therapeutic technique which should be part of an overall management strategy including medical treatment and surgery.
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PMID:[20 years of lumbar chymonucleolysis]. 869 48


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