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L.I. Pokotilo, Candidate of Medical Sciences, Director of the Family Doctor and Co clinic, Methods of using Karipain drugs for physiotherapists Using the drug Karipain fl. 1 g (powder) for the treatment of spinal diseases Karipain – a unique remedy for osteochondrosis and intervertebral hernias, obtained from papaya latex. The effectiveness of treatment with the drug for osteochondrosis and many (even complicated) disc herniations reaches 82%! More than 10 thousand patients have been successfully treated with the drug. Approximately 45% of patients scheduled for surgery, having received treatment with Karipain, do not require surgical intervention. The drug is also used for the treatment of joint contractures (post-traumatic and post-stroke), keloid scars of various origins, arthrosis, arthritis of large joints, glenohumeral peri-arthritis, cerebral (including optochiasmal) and spinal arachnoiditis, some forms of neuritis of the facial nerve, tunnel syndrome. In terms of medicinal properties, Karipain is an analogue of the Georgian drug Karipazim, which has not been imported into Russia since 2005.

Treatment of intervertebral hernias with Karipain The treatment method with papain-containing drugs has been used in medical practice for more than 10 years. The effectiveness of this technique has been confirmed by successful practice at the Central Research Institute of Traumatology and Orthopedics named after. N. N. Priorov (CITO), at the Research Institute of Neurosurgery named after. N. N. Burdenko, in the Omsk State Medical Academy of Roszdrav. Karipain contains biologically active substances of plant origin (Papain, Lysozyme, etc.), which have a positive effect on collagen cartilage tissue. These tissues make up the intervertebral discs and, accordingly, the hernia. At a certain concentration, Karipain, administered by electrophoresis, affects the hernia itself. It begins to gradually decrease and becomes soft. This, sometimes, is enough to release the nerve ending that it pinches, and the pain in the spine gradually goes away. Karipain also acts on the entire intervertebral disc. It becomes more elastic, “bouncy”, and increases height. The drug enhances the regeneration of disc tissue, which restores its normal shape and its function as a shock absorber. The administered Karipain affects several adjacent intervertebral discs, restoring the entire spine. Course treatment – from 1 to 3 courses of 20–30 procedures each, with an interval of 1 to 2 months between courses. The drug can be used in any medical institution where there is an apparatus for electrophoresis (for example, Potok-1) or phonophoresis. The technique is specially adapted for convenient use in clinics, medical units, hospitals and even at home. An additional component of complex treatment is special therapeutic exercises that strengthen the muscles of the back, abdomen, neck, and limbs, creating a “muscle corset” and stabilizing the spine, which allows the patient to more easily endure physical activity. In addition, if necessary, massage, gentle traction, careful manual therapy, and anti-inflammatory drug therapy are used. Between courses, patients are recommended to exercise in the pool. However, there are forms of the disease - sequestered hernias, with foramenal pinching of the nerves, with severe disruption of blood circulation in this area and unbearable, severe pain that requires absolute surgical intervention. In general, treatment tactics are chosen exclusively by doctors and must be agreed upon with the patient. Instructions for use Karipain fl. 1 g for physiotherapy rooms Karipain is a direct-acting proteolytic enzyme preparation of plant origin, obtained from papaya latex; in medical practice, a solution of its lyophilized white powder is used. Units of activity are expressed according to the classification of the International Federation of Pharmaceuticals (1 vial of Karipain corresponds to 350 Fip-PE). Pharmacological properties Karipain is characterized by broad-spectrum proteolytic activity. The drug contains three proteolytic enzymes (Papain, Chymopapain, Proteinase) and a mucolytic enzyme - Lysocin, containing sulfhydryl groups in their active centers. The optimal conditions for the action of Karipain are pH 5–7, temperature 37°C. Indications for use Karipain is a highly effective drug used in orthopedic, traumatological, neurosurgical and neurological clinics. It is especially effective for osteochondrosis of the spine, including various forms of herniated intervertebral discs and discogenic radiculitis, Schmorl's hernias, post-traumatic flexion contractures of the fingers, keloid scars of various origins, arthritic arthritis of large joints, glenohumeral periarthritis, cerebral (including including optochiasmal) and spinal arachnoiditis, neuritis of the facial nerve, tunnel syndromes. Side effects and measures to prevent them When using Karipain, allergic reactions are possible. In case of increased sensitivity, manifested by itching and fever, antihistamine therapy is carried out. Between the 5th and 8th procedures, a temporary exacerbation of the underlying disease is possible. Contraindications Do not use intravenously or intramuscularly, in case of acute inflammatory processes in tissues, in case of sequestration of a herniated disc and foraminal location of the sequester. Release form Karipain is available in bottles of 1 g (10 ml) N 10 pack. cardboard. Storage conditions The drug is stored in a dry place, protected from light, at a temperature from 0 to +20°C. The drug is used only under the supervision of specialists. Method of administration and dose Karipain is administered by electrophoresis from the positive pole. Course treatment – 1 course of 20 to 30 procedures. Breaks of 1–2 days between procedures are allowed. If necessary, repeat courses after 30–60 days. 1 bottle of Karipain is diluted in 5–10 ml of physiological solution immediately before the procedure. 2-3 drops of Dimexide are added to the solution. The solution is applied to white filter paper placed on the electrode pads. The dimensions of the electrode pad are 10 x 15 cm. Options for the location of the electrode pads: Longitudinal Karipain on the neck area (+). Eufillin on the lumbar region (–). Karipain on the neck area (+). Eufillin on both shoulders with a bifurcated electrode (–). Karipain on the lumbar region (+). Eufillin on the thigh area with a split electrode. Transverse Karipain to the lumbar region (+). Eufillin for the abdominal area. The temperature of the gaskets is in the range of 37–39 C. Controlled by a water thermometer. The current strength is up to 10–15 mA (at the beginning of each procedure it increases gradually). The exposure time from 10 to 20 minutes also increases gradually. Failure to comply with these parameters leads to a sharp decrease in the effectiveness of the drug. Electrophoresis of Karipain on the area of keloid scars Karipain directly on the scar (+). Eufillin or potassium iodide on the opposite surface, i.e. transversely (–). Karipain directly onto the scar (+). Eufillin longitudinally at a distance of 15–20 cm from the 1st pad (–). Electrophoresis for some forms of neuritis of the facial nerve Current strength from 1 to 5 mA. Karipain on the face in the form of a Berganier half mask (+). Eufillin on the interscapular area or on the opposite shoulder (–). Electrophoresis of Karipain for cerebral arachnoiditis (including optochiasmal) Current strength is from 1 to 2 mA. Karipain endonasally (+). Eufillin on the lower-cervical-upper-thoracic spine (–). Instructions for administration of Karipain fl. 1 g by phonophoresis method Phonophoresis (ultrasonic injection) of enzyme preparations, including Karipain, can be carried out according to the following method. A bottle of Karipain is dissolved in 5 or 10 ml of a 1% novocaine solution (depending on the area of sonication). The contents are applied (with a syringe) in drops to the affected area, followed by rubbing. Then a small layer of Vaseline oil is applied to ensure the necessary contact for transmitting ultrasonic vibrations to the tissues. When treating a damaged spine, the emitter is moved along the spinal column, but not in the middle, but at a distance of 1.5–2 cm from the central axis, along the so-called paravertebral lines. The ultrasound head moves slowly using circular and longitudinal movements simultaneously over the damaged areas where Karipain, coated with a layer of petroleum jelly, is applied. Specifically, ultrasound with a frequency of 800–1000 kHz is used on segmental zones paravertebrally on both sides, intensity 0.3–0.6 W/cm2, continuous mode, duration 8–10 minutes. on a field, while the area of one field should not exceed 150–250 cm2. 15–30 procedures are prescribed for one course of treatment; it is advisable to do the procedures daily. The required number of procedures is determined by the doctor. The number of courses is from 1 to 3, also determined by the doctor, the break between courses is 30–60 days. Attention : these methods are intended only for use by specialists who have the necessary knowledge and skills in the use of enzyme preparations using electrophoresis and phonophoresis. Application is carried out only on certified equipment for physiotherapeutic procedures.

Application of cream Karipain tube 50 ml for the treatment of diseases of the spine and joints Karipain cream is recommended to be used regularly for osteochondrosis, intervertebral hernias, arthritis, arthrosis, joint contractures and other diseases of the spine and joints. The cream is also used for keloid scars of various origins, screeds and adhesions. It is used as an independent remedy or in combination with electrophoresis of powder in Karipain fl bottles. 1 g (as recommended by doctors). Phonophoresis of Karipain cream (ultrasound administration) Karipain cream has a balanced composition of active substances with ultrasound conductors and therefore does not require any auxiliary components during ultrasonic administration. The action of Karipain is close to the Georgian Karipazim . The ointment consumption for ultrasonic administration is 10 ml per 200 cm2 of the sounded body area. Phonophoresis (ultrasound administration) of Karipain is carried out according to the following method. The required amount of ointment is squeezed out of the tube onto the affected area (spine, joints, keloid scars, area of adhesions) and evenly distributed over the affected surface by light rubbing. Then they begin the phonophoresis procedure itself. When treating a damaged spine, the emitter is moved along the spinal column, but not in the middle, but at a distance of 1.5–2 cm from the central axis, along the so-called paravertebral lines. The ultrasound head moves slowly using circular and longitudinal movements (simultaneously) over the damaged areas where a layer of Karipain is applied. Specifically, ultrasound with a frequency of 800–1000 kHz is used on segmental zones paravertebrally on both sides, intensity 0.3–0.6 W/cm2, continuous mode, duration 8–12 minutes. on a field, and the area of one field should not exceed 200 cm2. For acute pain syndrome, a pulsed radiation mode with a pulse duration of 10 ms is recommended. 10–30 procedures are prescribed for one course of treatment; it is advisable to do the procedures daily (breaks of 1–2 days are allowed). During treatment, physical activity on the body is contraindicated. The required number of procedures is determined by the doctor. The number of courses is from 1 to 3, also determined by the doctor, the break between courses is from 1 to 2 months. When treating joints, the intensity is increased to 0.7–0.9 W/cm2. The ointment is administered to the area of small joints of the hands and feet through a bag of water. For phonophoresis, it is better to use certified ultrasonic devices, for example, UZT-1.01 or UZT-1.07. These are the most versatile devices. They are used to treat diseases of internal organs, musculoskeletal and nervous systems using the ultrasound method. The phonophoresis procedure is prescribed by a doctor, and the procedure itself can be performed by either a physiotherapist or a nurse. They warn the patient that during the procedure he will feel pleasant warmth. Severe burning or severe pain indicates a violation of the rules of the procedure, excessive intensity, or poor tolerance of ultrasound (which is extremely rare). Instructions for external use of Karipain cream Karipain contains hyaluronic acid, which, in addition to its own medicinal properties, is a “transport” agent for the dosed delivery of other active substances of Karipain to damaged areas of the body. Therefore, the use of Karipain even without special physiotherapeutic procedures (ultrasound) is effective. Application The cream is applied to the appropriate areas of the body with massaging movements until completely absorbed into the skin 2-3 times a day. The course of application is 20–30 days. If necessary, repeat courses are given. The break between courses is from 1 to 2 months. During the use of Karipain, heavy physical exertion on the body is not recommended. It can be used during therapeutic massage, in physiotherapy rooms or in normal home conditions. Contraindications : individual intolerance to the components of the cream. Treatment must be carried out under the supervision of specialists using certified equipment!

We invite all interested parties to cooperate in the acquisition and implementation of medical practice. For any questions, please contact the general distributor of Karipain drugs - MedWave Group of Companies, Moscow or our regional dealers Tel., websites www.karipain.ru, www.caripain.ru, E-mail

Magazine "Polyclinic No. 3 2007", pp. 30–31