The effect of lower extremity nerve decompression on health-related quality of life and perception of pain in patients with painful diabetic polyneuropathy: a prospective randomized trial

• Published in: Diabetic medicine Vol. 32; no. 6; pp. 803 - 809
• Main Authors: Macaré van Maurik, J. F. M., Oomen, R. T. W., van Hal, M., Kon, M., Peters, E. J. G.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2015; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Decompression, Surgical - psychology; Diabetes; Diabetic Neuropathies - surgery; Female; Follow-Up Studies; Humans; Lower Extremity - innervation; Lower Extremity - surgery; Male; Middle Aged; Pain - etiology; Pain - surgery; Pain Measurement; Pain Perception - physiology; Quality of Life; Netherlands
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12732

Aims The aim of this study was to assess whether surgical decompression of nerves in the lower extremity in people with painful diabetic polyneuropathy would have an effect on health‐related quality of life and to determine minimal clinically important differences in pain and quality of life scores. Methods The design was a randomized controlled trial in which 42 participants with painful diabetic painful neuroapthy underwent unilateral decompression of nerves in their left or right leg, using the other leg as a control, with 12 months follow‐up. Surgical decompression was performed at the tibial, superficial, deep and common peroneal nerves. Preoperatively, and at 6 and 12 months post operatively, a visual analogue scale for pain and the 36 item short‐form health survey and EuroQual 5 Dimensions questionnaires were completed. Results At 12 months follow‐up, the visual analogue scale was significantly reduced, but decompression surgery did not significantly alter health‐related quality of life scores. The minimal clinically important difference for visual analogue scale reduction was determined at 2.9 points decrease, a threshold reached by 42.5% of the study population. Conclusions Although decompression surgery does not influence health‐related quality of life, it achieves a clinically relevant reduction of pain in ~42.5% of people with diabetic peripheral neuropathy. It can therefore be considered for patients who do not adequately respond to pain medication. What's new? This article presents the effects of surgical lower extremity nerve decompression in patients with painful diabetic polyneuropathy, in respect to pain and health‐related quality of life. Decompression of lower extremity nerves might be useful for pain relief when medication fails to achieve a decrease in pain symptoms, with the limitation that clinical effectiveness is achieved only in 42.5% of patients.