Daniels JP, Middleton L, Xiong T, Champaneria R, Johnson NP, Lichten EM, et al. Individual patient data meta-analysis of randomized evidence to assess the effectiveness of laparoscopic uterosacral nerve ablation in chronic pelvic pain
ABSTRACT There have been conflicting results in randomized trials of the effects of laparoscopic uterosacral nerve ablation (LUNA) in chronic pelvic pain. Our objective was to perform a meta-analysis using individual patient data (IPD) to provide the most comprehensive and reliable assessment of the effectiveness of LUNA.
Electronic searches were conducted in the Medline, Embase, PsycInfo and Cochrane Library databases from database inception to August 2009. The reference lists of known relevant papers were searched for any further articles. Randomized trials comparing LUNA with no additional intervention were selected and authors contacted for IPD. Raw data were available from 862 women randomized into five trials. Pain scores were calibrated to a 10-point scale and were analysed using a multilevel model allowing for repeated measures.
There was no significant difference between LUNA and No LUNA for the worst pain recorded over a 12 month time period (mean difference 0.25 points in favour of No LUNA on a 0-10 point scale, 95% confidence interval: -0.08 to 0.58; P = 0.1).
LUNA does not result in improved chronic pelvic pain.
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ABSTRACT: Chronic pelvic pain (CPP) is one of the most common pain conditions affecting women and can have a significant impact on quality of life. Assessment of women with CPP is best approached in a comprehensive, systematic manner that includes exploration of physiological and psychological causes. A range of treatment options that draw from conventional medicine and complementary and alternative modalities should be offered. The women's health nurse plays a pivotal role in all aspects of care.Beginnings (American Holistic Nurses' Association) 01/2010; 30(1):20-1. DOI:10.1111/j.1552-6909.2012.01403.x
Article: Chronic pelvic pain in women[Show abstract] [Hide abstract]
ABSTRACT: SUMMARY POINTS Chronic pelvic pain is a common and debilitating condition Women with chronic pelvic pain want to be taken seriously and attach a high value to identifying a cause for their pain No organic cause is found on laparoscopy in at least a third of women with chronic pelvic pain, and patients should be made aware of this before they consent to investigations Psychological symptoms, such as anxiety and depression, are frequently present Gynaecological treatment for chronic pelvic pain is often unsatisfactory even when directed by an identified cause A multidisciplinary approach is essential for effective managementBMJ (online) 10/2010; 341(oct05 2):c4834. DOI:10.1136/bmj.c4834 · 16.38 Impact Factor
- Obstetrics and Gynecology 05/2011; 117(5):1228. DOI:10.1097/AOG.0b013e3182175ba5 · 4.37 Impact Factor