ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > Spinal Roundtable

Spinal Roundtable Discuss Chymopapain Injection in the General Discussion forums; I had a Chymopapain injection just after it was FDA approved in 1983 for L4-L5 herniated disk. A controversial alternative ...

English (US)  Español (ES)  Francais (FR)  Deutsches (DE) 

Reply
 
LinkBack Thread Tools
  #1  
Old 04-09-2007, 04:44 PM
Junior Member
 
Join Date: Mar 2007
Posts: 15
Default

I had a Chymopapain injection just after it was FDA approved in 1983 for L4-L5 herniated disk.

A controversial alternative to surgery is injecting chymopapain into a herniated disk. Chymopapain, an enzyme obtained from the papaya plant, breaks down the noncollagen components of the nucleus pulposus. The procedure was introduced in the mid-1960s, and the FDA approved its use in 1983.

I remember feeling no different right after the painful injection which was done at the Cleveland Clinic. The doc sent me home and told me not to complian to him for 3 weeks. I woke up one day almost pain free and it has been a 24 year success.

I think this procedure would be a good alternative however I do not know if anyone in the USA is still practicing it due to several serious allergic reactions that had extreme consequences including paralysis and death. However I must say that great care was taken to test me prior to injection for sensitivity to the extract. Perhaps one of the reasons this has not gained popularity is that some of the injections were done in clinics and offices and not under great scrutiny such as in a hospital setting.

Just an FYI for some of you.
__________________
L4/5 rupture waterskiing 1983, successful Cheymopapain Injection Cleveland Clinic

1989 L4/5 Stinger Waterski jumping no treatment went away

1992 Cervical injury body surfing- no treatment- went away

1995 Cervical injury waterskiing- numbne
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
  #2  
Old 04-09-2007, 05:00 PM
Harrison's Avatar
Administrator
 
Join Date: Oct 2004
Posts: 6,159
Default

Charlie, this is fascinating, thx for sharing this info. Last year, Paul commented on this enzyme. And I was recently looking into this (and other enzymes like bromelain, from pineapple) for fibrin dissolution (non-spinal application). I didn't know it was approved! Was that ruling reversed?!

Lastly, if you could explain or speculate how this fixed your "flat tire," please do tell!
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
  #3  
Old 04-10-2007, 06:42 AM
Harrison's Avatar
Administrator
 
Join Date: Oct 2004
Posts: 6,159
Default

Interesting stuff. Here's a bit more information.
_______________________________________________

J.R. Coll. Surg. Edinb., 43, December 1998, 407—409

Chymopapain chemonucleolysis: a review of 105 cases

A. R. POYNTON, D. A. O’FARRELL, D. MULCAHY, N. T. CORRIGAN AND F. McMANUS
Department of Orthopaedic Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin, Ireland

A review of 105 consecutive cases of chymopapain chemonucleolysis for single level lumbar disc herniation was undertaken. Mean follow-up was 12.2 years (range 10—15.3). Patients were assessed using the Oswestry Disability Questionnaire. Eighty-seven patients were available for follow-up. An excellent or good response occurred in 58 patients (67%); four patients (4.5%) had a moderate response but were only minimally disabled. The treatment failed in 25 patients (28.5%) and 21 of these went on to surgery within a mean of 5.2 months (range 3 weeks—12 months). In 15 patients (71%) disc sequestration or lateral recess stenosis was found. Five of the remaining six cases had a large disc herniation at surgery. Surgery resulted in a significant improvement in nine cases. Discitis following chemonucleolysis occurred in six patients (5.7%). Chymopapain chemonucleolysis has a useful role in the management of lumbar intervertebral disc prolapse. However, its efficacy is dependent on careful clinical and radiological patient selection.

More here:

http://www.rcsed.ac.uk/journal/vol43_6/4360012.htm
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
  #4  
Old 04-10-2007, 07:22 PM
Junior Member
 
Join Date: Mar 2007
Posts: 15
Default

Harrison,

You know for me this was a long time ago 1983, I had been told that they stopped doing it, but just a quick google showed many recent articles so I wonder if it is still being done.

I think that the procedure is good for young patients because the enzime dissolves the pulpy inner disk material which has extruded into the nerve root causing the nerve irritation. As you know the inner pulpy material naturally degenerates around by the mid 30's as I recall.

I wouldn't doubt that you can get it done overseas. When I had it done, one of the benefits was that if it didn't work, you could always do surgery.
__________________
L4/5 rupture waterskiing 1983, successful Cheymopapain Injection Cleveland Clinic

1989 L4/5 Stinger Waterski jumping no treatment went away

1992 Cervical injury body surfing- no treatment- went away

1995 Cervical injury waterskiing- numbne
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
  #5  
Old 04-11-2007, 05:37 PM
Junior Member
 
Join Date: Mar 2007
Posts: 20
Default

Hey, I can confirm most of the above. I also had a chymopapaine injection and in, surprise, 1983 also. It did cure my immediate problem (ruptured disc, loss of feeling in right leg below the knee). But ... there's always a but, over the long term I believe it caused even more problems. 2 of the discs where they injected it are totally gone which is why I'm here ... facing ADR to replace both of them AND I've lived in constant pain for 15 years.

Oh and the allergic reaction is true too and also true is that Drs in the US don't do this anymore. As far as I know, anyway.

Rick
__________________
1980 SKiing accident;
1983 Herniated Disc-> Chymopapaine;
1986 Herniated Disc;
2005 RadioFrequency;
2006 RadioFrequency;
2006 Discogram
2006 MRI -> DDD L4/L5, L5/S1
2006 Surgeon Recommends Fusion
2007 I WANT ADR !!!
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
  #6  
Old 04-12-2007, 04:53 AM
Senior Member
 
Join Date: Mar 2006
Posts: 185
Default

I also had the chymopapain in 1983. It helped a little but I had to have the laminectomy soon thereafter. They say it is minimally invasive but be careful. If the injection is not placed correctly it can cause major problems (i.e. arachnoiditis).
__________________
Rob Wilson
2/06 L4/5, L5/S1 ADR Stenum Hospital - Iliac vein cut w/ occlusion of iliac vein and hematoma
12/06 thru 8/07 Laser Spine Institute - 6 surgeries on L3/4 both sides, L4/5 both sides, L5/S1 both sides

4/08 Bonati Institute - redo of L5/S1 right
8/08 Bonati Institute - redo of L5/S1 left
12/08 Bonati Institute - redo of L4/5 right and left

9/09 Piriformis surgery to remove piriformis muscle causing sciatica
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
  #7  
Old 04-12-2007, 05:29 AM
Banned
 
Join Date: Oct 2004
Posts: 954
Default

I know chymopapain is not used frequently in the US. However, it is still used in other countries.

Quote:
Chemonucleolysis
Chemonucleolysis using chymopapain, the first percutaneous intradiscal therapy, involves enzymatic dissolution of nucleus pulposus by way of hydrolysis of the charged proteoglycan component in the nucleus pulposus [16] . After the first isolation of chymopapain from crude papain derived from the papaya fruit in 1941 [17] , animal studies pursued possible clinical applications [14] [18] [19] . In 1963, chymopapain first was injected in a human patient for the treatment of unremitting sciatica caused by a herniated lumbar nucleus pulposus [20] . This procedure predominantly relieves radicular pain rather than back pain. Proper patient selection is paramount for the success of chemonucleolysis. Classic indications are symptomatic lumbar disc displacement indicated by MRI, CT scan, or myelography, and absence of other major causes of symptoms.

For the next 20 years, the efficacy of chymopapain was examined in clinical trials, and Chymodiactin, a new formulation of chymopapain, was approved for clinical use in 1983 [14] ; however, complications began to be reported. Intense back pain and stiffness were observed in 20%–40% of cases. Though rare, fatal complications such as anaphylaxis, transverse myelitis, cartilaginous endplate damage, and hemorrhage were reported [16] [21] [22] . It was suggested that an anaphylactic immunologic reaction induced by antigens of the chymopapain protein and neurotoxicity were the main causes of adverse affects [23] [24] .

Although less allergenic enzymes have been discovered, they are restricted to use in animal studies (eg, chondroitinase ABC) [25] [26] or there are insufficient data to support clinical use [27] . The manufacture and distribution of Chymodiactin was ceased in October 1999, ending for the time being its use in the United States [14] . Despite terminated use of chymopapain in most centers in the United States, some physicians continue to state that chemonucleolysis is safe, effective, and economical given appropriate patient selection and proper surgical technique [28] .

Orthopedic Clinics of North America
Volume 35 • Number 1 • January 2004
Quote:

Spine, Volume 31(24), 15 November 2006, pp E890-E897

Transforaminal Posterolateral Endoscopic Discectomy With or Without the Combination of a Low-Dose Chymopapain: A Prospective Randomized Study in 280 Consecutive Cases

Hoogland, Thomas MD, PhD; Schubert, Michael MD; Miklitz, Boris BSc; Ramirez, Agnes ***

From the Department of Spine Surgery, Alpha Klinik Munich, Munich, Germany.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Address correspondence and reprint requests to Thomas Hoogland, MD, PhD, Department of Spine Surgery, Alpha Klinik Effnerstr. 38 81925 Munich, Germany;

Study Design. A prospective randomized study involving 280 consecutive cases of lumbar disc herniation managed either by an endoscopic discectomy alone or an endoscopic discectomy combined with an intradiscal injection of a low dose (1000 U) of chymopapain.

Objective. To compare outcome, complications, and reherniations of both techniques.

Summary of Background Data. Despite a low complication rate, posterolateral endoscopic nucleotomy has made a lengthy evolution because of an assumed limited indication. Chemonucleolysis, however, proven to be safe and effective, has not continued to be accepted by the majority in the spinal community as microdiscectomy is considered to be more reliable.

Method. A total of 280 consecutive patients with a primary herniated, including sequestrated, lumbar disc with predominant leg pain, was randomized. A clinical follow-up was performed at 3 months, and at 1 and 2 years after the index operation with an extensive questionnaire, including the visual analog scale for pain and the MacNab criteria. The cohort integrity at 3 months was 100%, at 1 year 96%, and at 2 years 92%.

Results. At the 3-month evaluation, only minor complications were registered. At 1-year postoperatively, group 1 (endoscopy alone) had a recurrence rate of 6.9% compared to group 2 (the combination therapy), with a recurrence rate of 1.6%, which was a statistically significant difference in favor of the combination therapy (P = 0045). At the 2-year follow-up, group 1 reported that 85.4% had an excellent or good result, 6.9% a fair result, and 7.7% were not satisfied. At the 2-year follow-up, group 2 reported that 93.3% had an excellent or good result, 2.5% a fair result, and 4.2% were not satisfied. This outcome was statistically significant in favor of the group including chymopapain. There were no infections or patients with any form of permanent iatrogenic nerve damage, and no patients had a major complication.

Conclusions. A high percentage of patient satisfaction could be obtained with a posterior lateral endoscopic discectomy for lumbar disc herniation, and a statistically significant improvement of the results was obtained when an intradiscal injection of 1000 U of chymopapain was added. There was a low recurrence rate with no major complications. The method can be applied in any type of lumbar disc herniation, including the L5-S1 level.
Quote:
Kawano, Keiichiro. Tajima, Naoya. Hashida, Seiichi. Ishikawa, Eiji.
Institution Matsubashikawano Orthopaedic Hospital, 2-2-13 Matsubashi, Miyazaki, 880-0013, Japan.

Study of blood metabolism and urinary excretion of chymopapain following intradiscal injection using a high-sensitivity enzyme immunoassay.

Journal of Orthopaedic Science. 10(2):206-13, 2005.

Abstract To develop chymopapain-induced chemonucleolysis as an established treatment, it is necessary to determine the kinetics of chymopapain in blood and urine following intradiscal injection. To investigate the rate of blood metabolism and urinary excretion of chymopapain following intradiscal injection, we developed a high-sensitivity enzyme immunoassay for chymopapain. The sensitivity for this assay was 1 pg/tube (40 amol). After injecting chymopapain into the nucleus pulposus of humans, levels of blood chymopapain were measured by enzyme immunoassay. The level of chymopapain in blood decreased gradually, with a half-life of 2-3 days. The half-life for urinary excretion was a little longer, at 3 days. It was also found that chymopapain in blood was not present as a free molecule but formed a complex that had a molecular weight of about 120 kDa. These findings suggest that most chymopapain would not have activity in blood.
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
  #8  
Old 04-12-2007, 10:56 PM
Senior Member
 
Join Date: Apr 2006
Posts: 297
Default

My naturopath has had me on an anti-inflammatory for the last month or so.It's a Protease Papain and Bromelain complex called InflamZyme made by BioCeuticals.
I can't tell you how effective it is as I'm still taking small doses of other "prescribed" medications, but it's definitely enabled me to reduce the dosage of those.
Hope this helps.
__________________
Scoliosis 35*
DDD Everywhere!
The Usual Discograms Epidural Facet Injections etc
Maverick L4/5 Fusion L3/4
July 3 2006

Dynesys Stabilisation L4/5
Lt & Rt Facet Removal +Non-Bone Fusion L5/S1
May 26 2008
Digg this Post!Add Post to del.icio.usBookmark Post in TechnoratiFurl this Post!
Reply With Quote
Reply

Bookmarks

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are Off
Refbacks are On


Similar Threads
Thread Thread Starter Forum Replies Last Post
hip joint injection today CindyLou Spinal Roundtable 14 12-02-2008 09:39 AM
Cervical cortisone injection TamiJ Spinal Roundtable 2 04-18-2008 08:30 AM
Gel injection could do away with surgery Alastair The Regeneration Lab 7 03-27-2007 12:42 AM
Epidural Steroid Injection Tip luvmysibe Spinal Roundtable 5 05-10-2006 08:14 PM
Epidural Steroid Injection Marcia Spinal Roundtable 9 08-31-2005 03:16 AM


All times are GMT -4. The time now is 05:27 AM.


© Copyright 2006-2009 ADRSupport.org All rights reserved.

1 2 3 4 5 6 7 8 9 10 11 12