A new technique for "dissolving" the herniated pulpy nucleus of a lumbar disc was approved recently by the Food and Drug Administration. The technique, called "Chemonucleolysis," involves injecting an enzyme, derived from the papaya fruit, into the part of the disc that herniates (the part removed in laminectomy surgery).
The enzyme, chymopapain, is one of the active ingredients in meat tenderizer.
Although the technique may be less traumatic than surgery, the procedure may necessitate a short hospital stay and requires the services of neurosurgeons specially trained in the delicate skills involved.
The enzyme has caused allergic reactions in some people, ranging from rashes to potentially fatal anaphylactic shock. (Anaphylaxis has occurred in two men and 11 women in groups of 1,049 men and 536 women, according to the official reports of the manufacturer's premarket trials. Two patients died.) So far the injection has not been tested in children or pregnant women and has been used only in the lower back area.
As with other conventional treatments, this one presupposes that the pain is caused by the disc. Anyone considering either the injection or back surgery should seek several opinions and explore alternatives involving stress management and psychotherapy.
One excellent book on general chronic pain control is Pain Control, The Bethesda Program by Bruce Smoller, M.D., and Brian Schulman, M.D. ($15.95, Doubleday). Smoller, an orthopedist, and Schulman, a psychiatrist, use a psychobiological approach to pain control, including the relationship of stress.
For more information: Bethesda Pain Control Program, 4400 East-West Hwy., Suite G, Bethesda, Md., 20814. Tel. 654-5030.
Dr. John E. Sarno may be reached at the Institute for Rehabilitative Medicine (Rusk Institute) 400 E. 34th St. New York, N.Y. 10016. His book on Tension Myositis Syndrome will be published next year by the William Morrow Co.