An enzyme derived from the papaya, chymopapain has been used successfully for the treatment of lumbar disc protrusion for the past 25 years. It continues to be widely used in Europe and Asia, but less so in the United States, because of its limited availability. Chymopapain has been shown to be effective in dissolving disc material, and may be used alone, via direct injection into the protruding disc, or in combination with other minimally invasive procedures.
Rare side effects, including anaphylaxis and damage to the microcirculation of neural tissue, have been a source of some concern, and have contributed to a decline in popularity of chymopapain as a first line treatment for disc protrusion. Nevertheless, used appropriately, this agent has repeatedly been shown to be both safe and effective.