Sixteen studies were included (n=805): 11 case series, 2 controlled observational studies, and 3 RCTs.
Reviewer agreement on study inclusion ranged from 91-100% (kappa 0.81 - 1.0). Only one of the studies included in the review was a high quality RCT.
LUNA in pelvic pain without visible pathological appearances:
The 4 case series provided evidence of symptom relief in 36-91% patients at 6 - 12 months follow-up. In one quasi-randomised trial OR was 9.4 (95% CI: 0.7, 472, p=0.09). In a RCT comparing LUNA with pre-sacral neurectomy with an outcome of more than 50% pain relief achieved at 12 months OR was 0.24 (95% CI: 0.07, 0.8, p=0.01). Presacral neurectomy was associated with chronic constipation in 94% of patients.
LUNA in pelvic pain associated with endometriosis:
In 7 case series LUNA was associated with a beneficial effect in 72-93% of patients 12-18 months after operation. In one controlled observational study LUNA plus endometrial ablation was compared to endometrial ablation. Pain relief at 18 months follow-up OR was 36.7 (95% CI: 3.9, 1625, P=0.001). In another controlled observational study, LUNA was compared with laprascopic presacral neurectomy. Pain relief at 6 months OR was 0.30 (95% CI:0.04, 1.76, p=0.1). One RCT comparing LUNA plus endometrial ablation with laparoscopy alone showed resolution or improvement of symptoms at 6 months: OR was 5.7 (95% CI: 1.5, 343, p=0.003).