Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy

Yang, Weiqin; Guo, Zhuangli; Yu, Yanbing; Xu, Jun; Zhang, Li

doi:10.1053/j.jfas.2016.07.004

Cited by 16 publications

(18 citation statements)

References 33 publications

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“…In 2016, Yang et al reported the results of DNS at daytime, nighttime, and during peak pain (VAS scores) among eleven participants with intractable DPN pain at 2 weeks and 3, 6, 12, and 24 months post-DNS. 30 All three pain measures showed substantial improvement. For example, daytime pain fell from 7.9±0.6 to 4.5±1.5, 2.1±1.9, and 1.8±2.1 at 0.5, 12, and 24 months post-DNS, respectively.…”

Section: Resultsmentioning

confidence: 91%

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Albers

Jacobson

2018

DMSO

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AimTo assess lower extremity decompression nerve surgery (DNS) to treat the consequences of diabetic distal symmetric peripheral neuropathy (DPN).Research design and methodsMEDLINE, PubMed, and related registries were searched through December 2017 to identify randomized, quasi-randomized or observational trials that evaluated the efficacy of lower extremity DNS on pain relief (primary outcome) or other secondary outcomes. Observational studies were included, given investigators’ reluctance to use sham surgery controls. Outcome effect size was estimated, and a weighted average was calculated.ResultsEight of 23 studies evaluated pain relief, including a double-blind randomized controlled trial (with a sham surgery leg), an unblinded trial with a nonsurgical control leg, and 6 observational studies. All reported substantial pain relief post-DNS with average effect sizes between two and five. Unexpectedly, the double-blind trial showed improvement in the sham leg comparable to the DNS leg and exceeding the improvement observed in the nonsurgical leg in the unblinded study. Sensory testing showed generally favorable results supporting DNS, and nerve conduction velocities increased post-DNS relative to deterioration in controls. Ultrasound revealed fusiform nerve swelling near compression sites. Morphological results of DNS were generally favorable but inconsistent, whereas hemodynamic measures showed a positive effect on arterial parameters, as did transcutaneous oximetry (improved microcirculation). The incidence of initial and recurrent neuropathic diabetic foot ulcers appeared reduced post-DNS relative to the contralateral foot (borderline significant).ConclusionThe data remain insufficient to recommend DNS for painful DPN, given conflicting and unexpectedly positive results involving sham surgery relative to unblinded controls. The generally supportive sensory and nerve conduction results are compromised by methodological issues, whereas more favorable results support DNS to prevent new or recurrent neuropathic foot ulcers. Future studies need to clarify subject selection vis-à-vis DPN vs superimposed compressed nerves, utilize appropriate validated instruments, and readdress use of sham surgical controls in light of recent results.

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Section: Resultsmentioning

confidence: 91%

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Albers

Jacobson

2018

DMSO

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“…(13) Surgical Interventions . Patients with PN are prone to superimposed entrapment neuropathies, and in these cases, surgical decompression has been proven to significantly relieve pain [53], with patients' QoL also subsequently improving [54].…”

Section: Resultsmentioning

confidence: 99%

Quality of Life in Painful Peripheral Neuropathies: A Systematic Review

Girach

Julian

Varrassi

et al. 2019

Pain Research and Management

112

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Objective. Neuropathic pain is a common presenting complaint of patients with peripheral neuropathy (PN) and is considered one of the most disabling neuropathic symptoms, with detrimental effects on patients’ quality of life (QoL). The aim of this review was to overview the current literature that focuses on QoL in painful PN of various aetiologies. We sought to clarify the direct effect of pain and its treatment on patients’ QoL. Methodology. A systematic computer-based literature search was conducted using the PubMed database to search for papers on QoL in painful PN. Information was extracted regarding prevalence, demographics, and response to treatment where relevant. Results. We identified 66 articles eligible for inclusion. The vast majority of studies (n=47) focused on patients with diabetic PN. Other aetiologies of painful PN where QoL has been studied to date include gluten, immune-mediated, HIV, chemotherapy-induced, and chronic idiopathic axonal polyneuropathy. Pharmacological treatment is the mainstay in managing pain and has a direct positive and independent effect on the overall QoL. Other nonpharmacological approaches can also be of benefit, either alone or as adjuvant treatments, and are discussed. Conclusion. The findings demonstrate that QoL is impaired in painful PN and should not be neglected in clinical practice. Patients’ pain management and subsequent impact on QoL should routinely be assessed and monitored.

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“…In einer Metaanalyse der Cochrane Library konnte 2008 keine Empfehlung ausgesprochen werden, da nicht genug adäquat designte Studien vorlagen [17]. Seitdem finden sich in der Literatur jedoch zunehmend Hinweise auf die Wirksamkeit eines solchen Vorgehens [11,12,14,18]. Die signifikante Reduktion neuropathischer Schmerzen konnte sogar in einer randomisierten Studie festgestellt werden [13].…”

Section: Diskussionunclassified

Peronaeusparese bei akuter diabetischer Mononeuropathie mit vollständiger Erholung nach chirurgischer Dekompression – Ein Fallbericht und Literaturübersicht

Kolbenschlag

Daigeler

Hernekamp

et al. 2018

Handchir Mikrochir plast Chir

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ZusammenfassungDer Fall eines 47-jährigen Patienten mit Diabetes mellitus assoziierter Monoparese des N. peronaeus wird vorgestellt. Hieran wird die Prädisposition von Nerven für eine Kompression an präexistenten Engstellen im Rahmen der Grunderkrankung dargestellt. Diagnostik, Therapie und Verlauf werden beschrieben und im Kontext der Literatur diskutiert.

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Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy

Cited by 16 publications

References 33 publications

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Quality of Life in Painful Peripheral Neuropathies: A Systematic Review

Peronaeusparese bei akuter diabetischer Mononeuropathie mit vollständiger Erholung nach chirurgischer Dekompression – Ein Fallbericht und Literaturübersicht

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Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy

Cited by 16 publications

References 33 publications

Decompression nerve surgery for diabetic neuropathy:&nbsp;a structured review of published clinical trials

Decompression nerve surgery for diabetic neuropathy:&nbsp;a structured review of published clinical trials

Quality of Life in Painful Peripheral Neuropathies: A Systematic Review

Peronaeusparese bei akuter diabetischer Mononeuropathie mit vollständiger Erholung nach chirurgischer Dekompression – Ein Fallbericht und Literaturübersicht

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Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials