SLR - September 2019 - Charlene M. Dennemeyer
Reference: Best T.J., Best C.A., Best A.A., Fera L.A. Surgical Peripheral Nerve Decompression for the Treatment of Painful Diabetic Neuropathy of the Foot – A Level 1 Pragmatic Randomized Controlled Trial. Diabetes Res Clin Pract. 2019 Jan;147:149-156.
Scientific Literature Review
Reviewed By: Charlene M. Dennemeyer, DPM
Residency Program: North Colorado Medical Center – Greeley, CO
Methods: This is a single-blinded RCT including patients ≥18 years of age with DM type 1 or 2, HbA1c <8.0 percent, and with DPN. Peripheral nerve involvement was determined clinically and with nerve conduction studies (NCS). Twenty-one patients were randomized and analyzed. The intervention group underwent decompression of common peroneal, tibial, and deep peroneal nerves. The control group continued their usual treatment regimen. Follow up was at three, six, and 12 months. Average daily pain was measured on the 10-point McGill Pain Questionnaire VAS and the NeuroQoL scale. At baseline and 12 months, patients were assessed with the Total Neuropathy Score (TNS). The investigators were blinded to group allocations while gathering data. Primary outcomes were improvement in pain scores at 12 months compared to baseline and quality of life. Secondary outcomes included improvement in TNS score, tactile sensibility, and change in nerve conduction studies.
Results:- Intervention group had a longer duration of diabetes, worse glycemic control, were more likely taking oral antihyperglycemics and neuropathic pain agent
- No significant difference between McGill pain VAS between 12 months and baseline, however pain scores changed over time and pain reduction after surgery was greatest at three to six months
- NeuroQol demonstrated statistically significant changes of more than three points in pain scores at 12 months
- No significant difference between groups for secondary outcomes
- Intervention group was less likely to have poor nerve conduction studies after surgery compared to control
- Intervention group participants had over three times the odds of rating their overall pain as “better” as opposed to “worse” or “unchanged” compared to the control group