Sept. 1, 2009 -- The LUNA procedure -- minimally invasive surgery to cut pelvic nerves -- gives women no relief from chronic pelvic pain, a large U.K. trial shows.
Long-lasting pelvic pain is a big problem for women. Some causes of chronic pelvic pain can be diagnosed and treated:
- Pain from uterine tissue growing where it shouldn't, a condition called endometriosis
- Pain from infections, conditions known generally as pelvic inflammatory disease
- Adhesions -- tissues stuck together after improper healing from infections, disease, or surgery
About one in seven women experiences chronic pelvic pain, but many cases can't be directly traced to these conditions or cured by their treatment. The pain often comes during menstruation (dysmenorrhea), between menses (noncyclical pain), or during sex (dyspareunia).
When they can't find or treat the cause of the pain, doctors have tried to treat the pain itself -- by surgery to destroy nerves in the pelvis. This once was done by open surgery, but it's now more common for doctors to use a less invasive technique called laparoscopic uterosacral nerve ablation: LUNA.
Does it work? That's been controversial. But now there's been a major study of nearly 500 women with chronic pelvic pain lasting more than six months at 18 U.K. hospitals.
Women with chronic pelvic pain usually undergo laparoscopic examination in which a small tube is inserted into the pelvic region. Women in the study agreed to undergo LUNA -- or not -- if the exam did not identify a treatable cause for their pain (although women with minimal endometriosis were included).
Researchers evaluated the women's pain from three months to five years later.
The bottom line: "LUNA did not alleviate any type of pain ... or improve quality of life," report Jane Daniels, MSc, of Birmingham Women's Hospital, and colleagues.
So why have some doctors thought LUNA was successful? Daniels and colleagues found that three months after undergoing the procedure, women said they felt less pain -- regardless of whether they received LUNA or not.
"This early pain reduction may be a placebo effect and attributable to the reassurance provided by the laparoscopic examination that there was no serious pathology," the researchers suggest.
Unfortunately, although the findings will spare many women an unnecessary procedure, they leave women with no definitive treatment for a very real medical problem capable of disrupting lives and relationships.
Daniels and colleagues report the study results in the Sept. 2 issue of the Journal of the American Medical Association.