title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J F M
authors.initials: JF
authors.lastname: Macaré van Maurik
authors.affiliation: Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R T W
authors.initials: RT
authors.lastname: Oomen
authors.affiliation: Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Hal
authors.affiliation: Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kon
authors.affiliation: Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: E J G
authors.initials: EJ
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000523:psychology; 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; D010146:Pain / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement; D058748:Pain Perception / Q000502:physiology; D011788:Quality of Life