title: Value of surgical decompression of compressed nerves in the lower extremity in patients with painful diabetic neuropathy: a randomized controlled trial.
abstract: BACKGROUND
  The authors aimed to assess the effect of lower extremity nerve decompression surgery for painful diabetic polyneuropathy on pain and sensibility.
  
  
  METHODS
  The study was conducted as a single-center randomized controlled trial of one intervention with 1-year follow-up. Forty-two patients with painful diabetic neuropathy were included. After randomization, the lower extremity nerves were decompressed at four sites in one limb. The contralateral limb was used as control (within-patient comparison). All patients were assessed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcome was the visual analogue scale score 12 months after surgery. Secondary outcomes were Semmes Weinstein monofilament testing and two-point discrimination outcomes at 3, 6, and 12 months.
  
  
  RESULTS
  Visual analogue scale scores improved significantly from a mean of 6.1 (95 percent CI, 5.5 to 6.7) preoperatively to 3.5 (95 percent CI, 2.5 to 4.4) at 12 months postoperatively (p<0.001). The score was also significantly lower compared with the control leg score of 5.3 (95 percent CI, 4.4 to 6.2; p<0.001) at 12 months. Overall, 73.7 percent of the patients improved their score on the visual analogue scale, of which 35.7 percent had a decrease of more than five points.
  
  
  CONCLUSIONS
  Surgical decompression of the nerves of the lower extremity can be added as a therapeutic option for patients with painful diabetic neuropathy who show signs of chronic nerve compression by means of a positive Tinel or other diagnostic criteria, when pain medication fails to reduce pain to an acceptable standard.
  
  
  METHODS
  Therapeutic, I.
authors.affiliation: Utrecht and Amsterdam, The Netherlands From the Department of Plastic Surgery, University Medical Centre Utrecht; and the Department of Internal Medicine, VU University Medical Center.
authors.forename: Joanne F M Macaré
authors.initials: JFMM
authors.lastname: van Maurik
authors.forename: Mireille
authors.initials: M
authors.lastname: van Hal
authors.forename: Ruben P A
authors.initials: RPA
authors.lastname: van Eijk
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
authors.forename: Edgar J G
authors.initials: EJG
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000294:innervation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D016896:Treatment Outcome; D055815:Young Adult
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