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Laparoscopic Uterosacral Nerve Ablation Ineffective for Alleviating Chronic Pelvic Pain CHICAGO -- September 2, 2009 -- Laparoscopic uterosacral nerve ablation (LUNA) does not result in improvements in chronic pelvic pain, painful menstruation, painful sexual intercourse or quality of life when compared with laparoscopic surgery that does not interrupt pelvic nerve connections, according to a study published in the September 2 issue of JAMA. “Chronic pelvic pain in women is as common as asthma and chronic back pain, is one of the most difficult and perplexing of women’s health problems and has a multifactorial etiology,” the authors wrote. “Chronic pelvic pain has a major effect on health-related quality of life, work attendance and productivity, and health care use, and treatments for chronic pelvic pain are often unsatisfactory.” “LUNA was adopted by many practitioners because afferent nerves from pelvic organs pass through the utero-sacral ligament and it was thought that disruption of these would reduce the perceived pain.” Jane Daniels, Birmingham Women’s Hospital, University of Birmingham, Birmingham, United Kingdom, and colleagues from the LUNA Trial Collaboration conducted a randomised controlled study with 487 women with chronic pelvic pain at 18 hospitals in the United Kingdom between February 1998 and December 2005. The women were randomised to receive the LUNA procedure (n = 243) or laparoscopy without pelvic denervation (n = 244). Follow-up questionnaires were sent to study participants at 3 and 6 months and at 1, 2, 3, and 5 years. The primary outcome was pain and the secondary outcome was health-related quality of life. “After a median follow-up of 69 months, there were no significant differences reported on the visual analogue pain scales for the worst pain between the LUNA group and the no LUNA group,” the authors found. There were also no significant differences found for noncyclical pain, dysmenorrhea, or dyspareunia. Nor were there differences observed between the LUNA group and the no LUNA group for quality of life. “The LUNA trial was designed to assess the effects of LUNA compared with no denervation among women undergoing diagnostic laparoscopy for chronic pelvic pain. LUNA did not alleviate any type of pain or improve the quality of life, irrespective of the presence or absence of mild endometriosis,” the authors concluded. SOURCE: JAMA E-mail this page to a friend or colleague! To print, use this version