What does this research mean for the field?

Lower extremity nerve decompression (LEND) provides greater long-term pain relief and improved functional outcomes compared to medical therapy alone in patients with painful diabetic peripheral neuropathy (PDPN). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

March 14, 2026Open Access

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

CLChenlong LiaoJiangxi University of Traditional Chinese Medicine SLShuo LiHebei University of Technology WZWenxiang ZhongXinHua Hospital

Key Points

This study investigates the long-term effectiveness of lower extremity nerve decompression for painful diabetic peripheral neuropathy compared to medical management.
Conducted a retrospective cohort study including patients treated with LEND or medical therapy from 2008 to 2011.
Evaluated pain intensity with visual analogue scale, BPI-DPN for pain burden, HADS for psychological symptoms, and MQS-III for medication burden.
Performed exploratory prognostic factor and subgroup analyses based on pain distribution.
LEND group showed significantly greater pain relief (mean VAS change −5.63 vs −1.03; p < 0.001) compared to medical management.
Higher responder rates for pain reduction in the LEND group (65.8% vs 9.7%; p < 0.001).
Significant improvements in pain severity, anxiety, depression, and medication burden in LEND cohort (all p < 0.001).
Younger age and lower body mass index linked to better long-term pain outcomes after LEND.
Diabetic foot ulcer events decreased in the LEND group (0% vs 32.3%; p < 0.001).

Abstract

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 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.

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