Ultra-Long-Term Real-World Outcomes of Lower Extremity Nerve Decompression for Painful Diabetic Peripheral Neuropathy: A Retrospective Cohort Study.

INTRODUCTION

Lower extremity nerve decompression (LEND) for painful diabetic peripheral neuropathy (PDPN) remains controversial, and evidence regarding its long-term effectiveness in real-world clinical practice is limited.

METHODS

This retrospective real-world cohort study included patients with PDPN treated with LEND or medical therapy alone between 2008 and 2011. Ultra-long-term outcomes were assessed after > 10 years of follow-up. Pain intensity was evaluated using the visual analogue scale (VAS). Composite pain burden and functional impact were assessed with the Brief Pain Inventory for Diabetic Peripheral Neuropathy (BPI-DPN). Psychological symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), and analgesic medication burden was quantified by the Medication Quantification Scale III (MQS-III). Exploratory prognostic factor and subgroup analyses based on pain distribution were performed.

RESULTS

Seventy-six patients in the LEND group and 31 patients in the medical group were available for ultra-long-term analysis. Compared with medical management, LEND was associated with greater long-term pain relief (mean VAS change - 5.63 ± 2.16 vs - 1.03 ± 1.92; p < 0.001) and higher responder rates (≥ 50% pain reduction: 65.8% vs 9.7%; p < 0.001). Significant long-term improvements were also observed in BPI-DPN pain severity and pain interference (both p < 0.001), anxiety and depression symptoms (both p < 0.001), and medication burden (MQS-III p < 0.001). Within the LEND cohort, younger age at surgery and lower body mass index were independently associated with greater long-term pain improvement. Both focal and diffuse pain subgroups demonstrated significant improvements in pain and functional outcomes after surgery, with no meaningful differences at ultra-long-term follow-up. Diabetic foot ulcer events occurred less frequently after LEND (0% vs 32.3%; p < 0.001).

CONCLUSIONS

LEND demonstrated long-term efficacy in alleviating pain and concurrently improving the pain-related interference and psychological status of patients with PDPN. A Graphical Abstract is available for this article.

TRIAL REGISTRATION: This study was retrospectively registrated in Chinese Clinical Trial Registry chictr.org. cn (ChiCTR2500099348), https://www.chictr.org.cn/bin/project/edit?pid=266042 .