LUNA No Help For Pelvic Pain

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Sept. 1, 2009 — The LUNA procedure — minimally invasive surgery to cutpelvic 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 chronicpelvic pain can be diagnosed and treated:

  • Pain from uterine tissue growing where it shouldn’t, a condition calledendometriosis
  • Pain from infections, conditions known generally as pelvic inflammatorydisease
  • Adhesions — tissues stuck together after improper healing from infections,disease, or surgery

About one in seven women experiences chronic pelvic pain, but many casescan’t be directly traced to these conditions or cured by their treatment. Thepain 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 totreat the pain itself — by surgery to destroy nerves in the pelvis. This oncewas done by open surgery, but it’s now more common for doctors to use a lessinvasive technique called laparoscopic uterosacral nerve ablation: LUNA.

Does it work? That’s been controversial. But now there’s been a major studyof nearly 500 women with chronic pelvic pain lasting more than six months at 18U.K. hospitals.

Women with chronic pelvic pain usually undergo laparoscopic examination inwhich a small tube is inserted into the pelvic region. Women in the studyagreed to undergo LUNA — or not — if the exam did not identify a treatablecause for their pain (although women with minimal endometriosis wereincluded).

Researchers evaluated the women’s pain from three months to five yearslater.

The bottom line: “LUNA did not alleviate any type of pain … or improvequality of life,” report Jane Daniels, MSc, of Birmingham Women’s Hospital, andcolleagues.

So why have some doctors thought LUNA was successful? Daniels and colleaguesfound that three months after undergoing the procedure, women said they feltless pain — regardless of whether they received LUNA or not.

“This early pain reduction may be a placebo effect and attributable to thereassurance provided by the laparoscopic examination that there was no seriouspathology,” the researchers suggest.

Unfortunately, although the findings will spare many women an unnecessaryprocedure, they leave women with no definitive treatment for a very realmedical problem capable of disrupting lives and relationships.

Daniels and colleagues report the study results in the Sept. 2 issue of theJournal of the American Medical Association.

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