Treatment by Tenderizer

Papain, an enzyme derived from the papaya plant, is a familiar item to most housewives. Sold in grocery stores as a meat tenderizer, it can make even the toughest cuts easy to chew. Now papain is moving from the kitchen into the operating room. At hospitals in Boston and Chicago, doctors are using the extract (known medically as chymopapain) to tenderize slipped spinal discs, a treatment that relieves pain and spares many patients surgery.

Spinal discs, cushionlike pads that separate the vertebrae, are composed of tough, cartilaginous fibers and filled with water and a protein called "ground substance." When surrounding tissues tear, the disc bulges, or slips, out of its normal position, causing pain in the back and, when it pushes against the sciatic nerve, in the legs.

Most slipped discs can be treated successfully by the prescription of bed rest or aspirin or other painkillers. If the pain persists, doctors frequently perform a laminectomy, a delicate surgical procedure in which the disc is removed from between two vertebrae, which are then fused together. But in many cases, chymopapain may now provide an alternative to surgery. The enzyme injected into the disc breaks down the ground substance, enabling it and the water to escape and be absorbed by the body. That causes the disc to shrink back into place, thus easing the pressure on the surrounding nerves.

Encouraging Effects. Doctors have found that the treatment works best on young patients with badly herniated discs and severe sciatica that has not responded to traditional treatment. They warn that chymopapain produces severe allergic reactions in about 1% of the patients and therefore must be administered under general anaesthetic at a hospital, where doctors can deal promptly with any adverse reaction.

The still experimental enzyme treatment has not yet been approved by the Food and Drug Administration for widespread application. Thus use of the substance is restricted to certain medical centers that are still investigating its efficacy and safety. But those who have used chymopapain for slipped discs have uniformly reported good results. For example, at Massachusetts General Hospital, which recently opened a clinic to treat back problems, Drs. James Huddleston and Robert Boyd have injected chymopapain into 250 slipped-disc sufferers over the past 2% years. In three-fourths of the cases, they report, both the rupture and the pain were relieved.

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