The end result is a wall-like deposit of insoluble proteins, particularly fibrin. This insoluble fibrin formation leads to local circulatory interference that causes pain. The therapeutic use of protease enzymes is most effective at this stage of inflammation because they hydrolyze the peptide bonds that join amino acids within a protein, thus dissolving the fibrin plugs. This fibrin reduction allows more oxygen to reach and revive tissue cells. Excess fluid is also reabsorbed, reducing inflammation.
Research indicates that certain mixtures of proteolytic enzymes exhibit anti-inflammatory effects.
Examples include pancreatin, trypsin, and chymotrypsin from animal sources, and bromelain and papain from plant sources. The patients received the mixture prior to dental surgery and postoperatively for several days. A separate German review of a study found proteolytic enzymes have analgesic effects based on the inhibition of inflammation as well as their direct influence on the network of pain receptor branches known as nociceptors. This latter point explains the therapeutic effects of such enzymes in cases where the inflammatory processes are not in the fore-front, particularly degenerative rheumatic diseases. Enzyme preparations are generally well tolerated.