Hilgers, T. W. (2004). Chapter 80: Chronic Pelvic Pain and Dysmenorrhea. In The Medical and Surgical Practice of NaProTECHNOLOGY (pp. 1075-1082).
Hilgers TW. Chapter 80: Chronic Pelvic Pain and Dysmenorrhea. In: The Medical and Surgical Practice of NaProTECHNOLOGY. 2004. p. 1075-1082.
Hilgers, T. W. "Chapter 80: Chronic Pelvic Pain and Dysmenorrhea." The Medical and Surgical Practice of NaProTECHNOLOGY, 2004, pp. 1075-1082.
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Pope Paul VI Institute for the Study of Human Reproduction, Omaha, Nebraska.027jqx654
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RRM Academy Synopsis
Pain scores fell from severe to mild after endometriosis surgery
A textbook chapter reports that pelvic pain scores fell from severe to mild after endometriosis surgery in 234 women. One center treated them by laser laparoscopy (152) or laser laparotomy (82), each with a step called LUNA that divides pelvic nerves. Pain scores were followed over the first year.
Key Findings
The series had 234 women with endometriosis and severe, long-lasting pelvic pain with periods: 152 had laser laparoscopy and 82 had laser laparotomy.
Average pain scores fell from the severe range before surgery to the mild range across the first year of follow-up in both groups.
Later hysterectomy was infrequent and did not differ significantly between the groups. Adenomyosis was almost invariably the reason.
Reports put abnormal findings at diagnostic laparoscopy for this pain anywhere from 9 to 80 percent. A physician group says that spread suggests differing surgeon skill.
One estimate counts 9,200,000 US women with this pain each year, and about one-third will eventually visit a doctor for it.
Interpretation
This chapter describes 234 women with severe pelvic pain from endometriosis. Each had surgery plus LUNA, a step that cuts nerves near the uterus. Their pain fell to the mild range within a year. The drop held for both surgery types. Later hysterectomy stayed uncommon and similar between the two groups. The findings support larger studies of pain outcomes after LUNA-paired surgery for endometriosis.
RRM Context
The authors write within NaProTECHNOLOGY. They say oral contraceptives and GnRH agonists give short pain relief while the disease stays in place. RRM's surgical standard for endometriosis is excision. The laparoscopic group here had laser vaporization of implants, so these results describe that technique.
Our editorial summary of this paper, not the article's abstract.
Abstract
This chapter addresses chronic pelvic pain that is predominantly menstrual in presentation and describes the history, the Pope Paul VI Institute pelvic pain scale and the physical examination used in evaluation. The chapter states that oral contraceptives and GnRH agonists can be temporarily helpful in pain relief but offer no long-term effect, and it reports that the overwhelming majority of its patients with these symptoms have endometriosis. In a series of 234 patients with chronic and severe pelvic pain and dysmenorrhea secondary to endometriosis, treated by laser laparoscopy (n=152) or laser laparotomy (n=82) with laser uterosacral nerve ablation (LUNA), mean pain scores of 2.71 and 2.74 before surgery fell to the mild range during the first year of follow-up (p<.0001). Subsequent hysterectomy was reported in 12.2 percent of the laparoscopy group and 10.2 percent of the laparotomy group, and the chapter states that the reason was almost invariably adenomyosis.
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