LUNA No Help for Pelvic Pain
Nerve-Severing Procedure Gives Women No Relief From Chronic Pelvic Pain
By
Daniel J. DeNoon
WebMD Health News
Reviewed By
Louise Chang, MD
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.
SOURCES: Daniels, J. Journal of the American Medical Association, Sept. 2,
2009; vol 302: pp 955-961.
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