Trypsin-Chymotrypsin for Lumbar Disc Prolapse: Not Recommended
There is insufficient evidence to support the use of trypsin-chymotrypsin combination for reducing inflammation in prolapsed lumbar discs, and the limited available data suggests it provides minimal benefit beyond placebo. 1
Evidence Quality and Findings
The only identified study directly examining this intervention was a double-blind, placebo-controlled trial from 1975 that evaluated "Chymoral" (a trypsin-chymotrypsin combination) in 93 patients with lumbar disc prolapse of less than six months duration. 1
Key Results from the Available Evidence:
Minimal clinical benefit: While patients receiving the enzyme combination showed statistically significant improvement in straight-leg raising and required fewer analgesics compared to placebo, no differences were observed in other clinical parameters. 1
Similar treatment failure rates: Equal numbers of patients from both the treatment and placebo groups required further therapy, indicating no meaningful impact on disease progression or overall outcomes. 1
Overall conclusion: The study authors concluded that the value of this enzyme combination "seemed little better than a placebo" for treating lumbar disc prolapse. 1
Current Guideline-Based Approach to Lumbar Disc Prolapse
Modern evidence-based guidelines do not include proteolytic enzyme combinations in the treatment algorithm for lumbar disc herniation. 2
Recommended Conservative Management:
Initial approach: Patient education about favorable prognosis, remaining active (more effective than bed rest), and structured physical therapy focusing on core strengthening and flexibility. 3
Pharmacological options: Short-term NSAIDs for pain relief while focusing on active rehabilitation; opioids should be avoided as first-line therapy. 3
Injection therapies: Epidural steroid injections may provide short-term relief (less than 2 weeks to 6 weeks) in selected patients with chronic low-back pain, though evidence is weak. 2
Emerging Evidence on Inflammation Management:
Inflammation-preserving approach: A recent 2024 prospective study demonstrated that avoiding anti-inflammatory medications (NSAIDs, steroids) while using gabapentin and acupuncture resulted in 100% disc resorption rates within one year, higher than the 66.7% rate reported in meta-analyses of conventional treatment. 4
Novel therapeutic approaches: Research into multifunctional hydrogels for sustained anti-inflammation and ROS removal shows promise but remains experimental. 5
Critical Pitfalls to Avoid
Routine imaging: Should be avoided in the first 4-6 weeks unless red flags are present (progressive neurological deficits, cauda equina syndrome, cancer history, suspected infection). 3
Benzodiazepines: Should not be used routinely in patients with lumbar disc prolapse, as they prolong hospital stays and reduce the probability of pain reduction compared to placebo. 6
Surgical discectomy: Provides faster relief from acute attacks than conservative management in carefully selected patients with sciatica, but effects on lifetime natural history remain unclear. 7
Bottom Line
The trypsin-chymotrypsin combination lacks robust evidence for efficacy in lumbar disc prolapse and is not part of contemporary evidence-based treatment algorithms. 1 Focus should remain on proven conservative measures including activity modification, physical therapy, and judicious short-term use of NSAIDs when needed. 3