Table 10Key outcomes of surgical interventions for noncyclic CPP

Author, Year, Country
Quality
Comparison Groups, NOutcomes
Adhesiolysis
Swank et al., 200393 Netherlands
Quality: Good
G1: Adhesiolysis at diagnostic laparoscopy, 51
G2: No adhesiolysis at diagnostic laparoscopy, 47
  • No significant differences in 100cm VAS pain score at 12 months between either group (P = 0.63)
Hysterectomy vs. nonsurgical therapy
Carlson et al., 199454 U.S.
Quality: Poor
G1: Nonsurgical management, 50
G2: Hysterectomy, 68
  • Significant improvement in both groups in # days with pain at 12 months: G1: 16 to 9 days, P < 0.001; G2: 19 to 1 day, P < 0.001
  • Significant decreases in proportions of women with problematic pain at 12 months vs. baseline reported for both groups (P < 0.001 for both)
LUNA vs. diagnostic laparoscopy
Daniels, 200951, UK

Quality: Fair
G1: LUNA at diagnostic laparoscopy, 185
G2: No LUNA at diagnostic laparoscopy, 185
  • No significant difference between groups in 10cm VAS for noncyclic pain level at 12 months
Johnson, 200480, New Zealand

Quality: Poor
G1a: LUNA at diagnostic laparoscopy, no endometriosis, 18
G2a: No LUNA at diagnostic laparoscopy, no endometriosis, 32
G1b: LUNA at diagnostic laparoscopy, with endometriosis, 26
G2b: No LUNA at diagnostic laparoscopy, with endometriosis, 30
  • No significant differences in change from baseline of nonmenstrual pelvic pain score on 10-point VAS at 12 months between G1a vs. G2a (p = 0.34) or G1b vs. G2b (p = 0.58)
  • No significant differences in > 50% reduction of pain from baseline at 12 months on 10-point VAS between G1a vs. G2a ( p = 0.80) or G1b vs. G2b ( p = 1.0)
  • No significant differences in numbers of successful treatments at 12 months between G1a vs. G2a ( p = 0.85) or G1b vs. G2b ( p = 0.77)
LUNA vs. utero-sacral ligament resection
Palomba, 200694, Italy

Quality: Poor
G1: LUNA, 36
G2: Utero-sacral ligament resection, 38
  • Comparable pain severity scores on 100mm VAS at 12 months reported for both groups ( p = 0.063)
  • Relative risk of cure rates (complete relief of pain and CPP not requiring treatment) between G1 vs. G2 = 0.90 (95% CI: 0.78 – 1.33)
Surgical vs. nonsurgical therapy
Lamvu et al., 200670 U.S.

Quality: Poor
G1: Nonsurgical therapy, 181
G2: Surgical therapy, 189
  • MPQ scores after 12 months of therapy were significantly lower in both groups (both p < 0.001), but not significantly different from each other (p = 0.165)
  • Overall odds of improvement in MPQ score for surgical vs. nonsurgical treatments were similar (OR = 1.2, 95% CI [0.8, 1.6]
  • Comparable numbers of patients in each group with worsened pain (OR = 0.9, 95% CI [0.5, 1.5]), no change in pain (OR = 1.1, 95% CI [0.7, 1.7]), improvement in pain (OR = 0.8, 95% CI [0.4, 1.6]), and resolution of pain (OR = 0.9, 95% CI [0.5, 1.5])
Peters et al., 199175, Netherlands

Quality: Poor
G1: Standard treatment approach, including routine diagnostic and/or therapeutic laparoscopy, 49
G2: Integrated treatment approach, without routine laparoscopy, 57
  • No difference in numbers of patients with improvement in MPQ scores at 12 months between groups (p = 0.38)
  • Significant improvement in numbers of patients with improvement in relative disturbance of daily activities for those treated with integrated approach vs. standard approach (p < 0.01)

CPP = noncyclic chronic pelvic pain; G = group; LUNA = laparoscopic utero-sacral nerve ablation; MPQ = McGill Pain Questionnaire; OR = odds ratio; VAS = visual analog scale.

From: Results

Cover of Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness
Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness [Internet].
Comparative Effectiveness Reviews, No. 41.
Andrews J, Yunker A, Reynolds WS, et al.

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