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

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. 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. 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). 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. This study was retrospectively registrated in Chinese Clinical Trial Registry chictr.org. cn (ChiCTR2500099348), https://www.chictr.org.cn/bin/project/edit?pid=266042 . Painful diabetic peripheral neuropathy is a common nerve condition caused by diabetes that leads to long-lasting nerve pain, reduced physical function, emotional distress, and long-term use of pain medicines. Many people do not achieve adequate relief with medication alone, and information on long-term outcomes of different treatment approaches is limited. In this study, researchers compared people with painful diabetic peripheral neuropathy who underwent lower extremity nerve decompression surgery, a procedure that relieves pressure on nerves in the legs, with people who continued medical treatment alone. The researchers followed participants for > 10 years and measured pain levels, how pain affected daily activities, emotional symptoms such as anxiety and depression, and the amount of pain medication used. People who had surgery experienced much greater long-term pain relief than those treated with medication alone, with about two-thirds achieving at least a 50% reduction in pain compared with fewer than one in ten in the medical treatment group. Surgical patients also showed lasting improvements in daily functioning and emotional symptoms and reduced need for pain medicines. Younger age and lower body weight were linked to better long-term pain improvement after surgery. People with different patterns of leg pain all showed sustained benefit after surgery. These findings suggest that nerve decompression surgery may offer long-lasting symptom improvement for selected people with painful diabetic peripheral neuropathy and may help patients and clinicians make more informed long-term treatment decisions.