Pain response post-chemonucleolysis or disc excision.

Eighty-five patients with proven lumbar disc displacement who had failed at least 3 months of conservative care were enrolled in this prospective study. The patients were self-selected into one of three treatment groups: collagenase, chymopapain, or surgery, based on information provided regarding the nature benefits and risks of each. Pain levels were self-recorded by patients in the post-treatment period, and follow-up physical examinations were performed and data were collected regarding hospital stay and return to activities for 3 months post-treatment. Patient's pain perception post-treatment was statistically lowest in the surgically treated group. The enzyme-injected patients reported higher levels of pain perception throughout the follow-up period, with collagenase-treated patients reporting more pain than chymopapain patients. Surgical patients had the most satisfactory outcome of treatment at 3 months. An explanation regarding the differences in pain response to the two enzymes is offered based on in vitro studies of the effects of the enzymes on the two major structural macromolecules of the connective tissue matrix.