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Noncyclic Chronic Pelvic Pain Therapies for Women

Slide: 17 of 24

Comparative Effectiveness of Surgical Interventions for Noncyclic CPP: Pain and Quality-of-Life Outcomes (1 of 2)

Seven studies were identified that addressed surgical interventions for CPP. Of these, one was of good quality, one was fair quality, and five were of poor quality.

Evidence from two RCTs failed to support the superiority of LUNA over diagnostic laparoscopy for improving pain. ?In a fair-quality RCT, 370 women with CPP were randomized to undergo LUNA or no intervention at the time of diagnostic laparoscopy. Mean difference in pain scores measured on a 10-cm visual analog scale was not significantly different between the LUNA group and diagnostic laparoscopy group when patients were followed up at 1 year and 5e years. The mean difference in pain scores between the two groups was between -0.02 and -0.04 for the worst pain level and between 0.17 and 0.11 for noncyclic pain at 1 year and over all time points, respectively. In the second RCT of women with CPP, which was assessed to be of poor quality, there was no significant difference in pain scores on a 10-cm visual analog scale between the LUNA group and diagnostic laparoscopy group at 1 year. The lack of difference in pain scores between the two groups at 1 year was independent of the presence of endometriosis in these women. The strength of evidence for these findings was rated as low.

A good-quality RCT assessed the effectiveness of laparoscopic adhesiolysis when compared with no adhesiolysis after diagnostic laparoscopy in 98 women with abdominal adhesions. After 12 months of followup, both the laparoscopic adhesiolysis group and the diagnostic laparoscopy group reported decreases in pain scores on a 100-mm visual analog scale; however, there was no difference in pain reduction between the two groups (p = 0.63). The strength of evidence for this finding was rated as low.