Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial.
BACKGROUND
Chronic pelvic pain is a common condition with a major effect on health-related quality of life, work productivity, and health care use. Operative interruption of nerve trunks in the uterosacral ligaments by laparoscopic uterosacral nerve ablation (LUNA) is a treatment option for patients with chronic pelvic pain.


OBJECTIVE
To assess the effectiveness of LUNA in patients with chronic pelvic pain.


METHODS
Randomized controlled trial of 487 women with chronic pelvic pain lasting longer than 6 months without or with minimal endometriosis, adhesions, or pelvic inflammatory disease, who were recruited to the study by consultant gynecological surgeons from 18 UK hospitals between February 1998 and December 2005. Follow-up was conducted by questionnaires mailed at 3 and 6 months and at 1, 2, 3, and 5 years.


METHODS
Bilateral LUNA or laparoscopy without pelvic denervation (no LUNA); participants were blinded to the treatment allocation.


METHODS
The primary outcome was pain, which was assessed by a visual analogue scale. Data concerning the 3 types of pain (noncyclical pain, dysmenorrhea, and dyspareunia) were analyzed separately as was the worst pain level experienced from any of these 3 types of pain. The secondary outcome was health-related quality of life, which was measured using a generic instrument (EuroQoL EQ-5D and EQ-VAS).


RESULTS
After a median follow-up of 69 months, there were no significant differences reported on the visual analogue pain scales for the worst pain (mean difference between the LUNA group and the no LUNA group, -0.04 cm [95% confidence interval {CI}, -0.33 to 0.25 cm]; P = .80), noncyclical pain (-0.11 cm [95% CI, -0.50 to 0.29 cm]; P = .60), dysmenorrhea (-0.09 cm [95% CI, -0.49 to 0.30 cm]; P = .60), or dyspareunia (0.18 cm [95% CI, -0.22 to 0.62 cm]; P = .40). No differences were observed between the LUNA group and the no LUNA group for quality of life.


CONCLUSIONS
Among women with chronic pelvic pain, LUNA did not result in improvements in pain, dysmenorrhea, dyspareunia, or quality of life compared with laparoscopy without pelvic denervation.


BACKGROUND
controlled-trials.com Identifier: ISRCTN41196151.
Daniels
Jane
J
Department of Obstetrics and Gynecology, Birmingham Women's Hospital, University of Birmingham, Metchley Park Road, Edgbaston, Birmingham, B15 2TG UK. j.p.daniels@bham.ac.uk
Gray
Richard
R
Hills
Robert K
RK
Latthe
Pallavi
P
Buckley
Laura
L
Gupta
Janesh
J
Selman
Tara
T
Adey
Elizabeth
E
Xiong
Tengbin
T
Champaneria
Rita
R
Lilford
Richard
R
Khan
Khalid S
KS
D000290:Adnexa Uteri / Q000294:innervation*; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003714:Denervation; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D010535:Laparoscopy; D053685:Laser Therapy; D008875:Middle Aged; D010147:Pain Measurement; D017699:Pelvic Pain / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D016037:Single-Blind Method; D014599:Uterus / Q000294:innervation; D055815:Young Adult