On the basis of the encouraging results of the initial series, this technique should be considered as an interesting therapeutic alternative in sciatica. Larger series and double-blind studies, however, are necessary to confirm the initial results. We review the indications, complications, and clinical results, and discuss the tissue effects of chymopapain. The results following surgical disc removal versus chymopapain injection indicate that surgery with removal of the disc hernia through a small laminotomy remains the documented treatment of choice for patients with proven disc herniation and sciatica in whom conservative treatment has failed. The method, therefore, should not be regarded as an alternative to surgery but as the last stage of conservative treatment.
Allergic reactions are the only true side-effects and require special precautions.
The role of psychological distress and personality in the incidence of sciatic pain among working men. The role of personality characteristics and psychological distress in the incidence of sciatic pain was investigated in a 3-year prospective study. The psychological distress and personality characteristics were assessed by the Middlesex Hospital Questionnaire and the Maudsley Personality Inventory. The multivariate analysis of psychological factors, taking into account individual and occupational factors, showed that only hysteria was significantly associated with the incidence of sciatic pain among the blue-collar workers. Among the white-collar workers, none of the psychological dimensions were associated with sciatic pain.