Lower extremity nerve decompression for superimposed peripheral neuropathy in diabetes: awareness among medical professionals.

Background: In 2009, a Dutch survey disclosed that 23% of medical professionals involved in diabetes care acknowledged the role of superimposed nerve compression in diabetic sensorimotor polyneuropathy (DSP) symptoms, although less than 10% were aware of the potential value of nerve decompression surgery. Our current aim was to assess whether awareness changed since this survey together with an updated review of the literature.

Methods: A cross-sectional, national, multi-institutional survey-based study was conducted among professionals from different specialties in the Netherlands including general practitioners, endocrinologists, neurologists, plastic surgeons, vascular surgeons, orthopedic surgeons, neurosurgeons, anesthesiologists, diabetes specialist nurses and podiatrists.

Results: Among the 730 respondents, 84% confirmed their involvement in diabetes care. 57% (versus 23% in 2009) stated to be aware of the concept that superimposed nerve compressions play a role in the symptoms of DSP and 74% (previously: 60%) believed that this could be the case. In their communication to patients, 78% (versus 45%) of the professionals explained that DSP was irreversible. 30% (versus 3%) reported to refer patients to a surgeon. The reviewed literature reports an encouraging effect regarding pain reduction and PROMs, albeit with inconsistencies in outcomes related to sensibility (static one-point, two-point discrimination) and nerve conduction parameters.

Conclusions: In the last 13 years, studies reporting positive effects of surgery on both patient-reported outcomes and post-operative pain have raised an increased awareness on lower extremity neuropathy and LEND surgery with significantly more referrals to surgeons. However, long-term outcomes and appropriate patient selection criteria for LEND surgery are still needed.