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Nerve Decompression Study Offers Provocative Findings

VOLUME: 18         PUBLICATION DATE: Nov. 01, 2005

Issue Number: 11

Author(s): By Brian McCurdy, Associate Editor

    While previous studies have touted the benefits of peripheral nerve decompression for patients with neuropathy, a new study in the Journal of the American Podiatric Medical Association (JAPMA) reveals positive effects on sensation, neuropathic pain and patient balance. Authors of the study found that 87 percent of patients with numbness reported improved sensation and 92 percent who had preoperative balance problems had improved balance a year after undergoing the procedure.


    According to the study, which involved 60 patients with diabetic neuropathy and 40 patients with idiopathic neuropathy, the authors performed neurolysis of the peroneal nerve at the knee and the dorsum of the foot. They also released the tibial nerve in the four medial ankle tunnels.


    The improved balance is important as it can prevent falls and further injury, according to study co-author A. Lee Dellon, MD, a Professor of Plastic Surgery and Neurosurgery at Johns Hopkins University in Baltimore. Researchers of the JAPMA study say the study is the first to depict a change in balance associated with restoring sensation. However, they note a previous report that demonstrated a relationship between progressive losses of sensation and balance.


    In regard to neuropathic pain, the study found that the majority of patients ha
d significant pain reduction a year after undergoing the surgery. Researchers ranked patients’ pain on a visual analog scale (VAS) from 1 to 10 (with 10 being the worst pain) and found that 86 percent of those with preoperative pain higher than a 5 on the VAS showed postoperative improvement. Out of the 99 patients who related having pre-op pain, their pain after surgery improved by an average of 6.4 points on the VAS. Forty-four patients reported pain at the highest level of 10 before surgery but only 2 percent of these patients noted their post-op pain at 10 on the VAS, according to the JAPMA study.


    Stephanie Wu, DPM, says peripheral nerve decompression may be effective when nerve compression and entrapment contribute to neuropathy. On the other hand, surgical decompression may not be as effective when nerve entrapment and compression do not contribute to neuropathy, notes Dr. Wu, an Assistant Professor in the Department of Surgery at the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University School of Medicine.

How Does Nerve Decompression Compare To Medications For Neuropathy?

    Does the surgery provide greater relief than the various pharmaceuticals available? Medications for neuropathy, such as gabapentin (Neurontin, Pfizer) or duloxetine HCl (Cymbalta, Eli Lilly), distract the brain from the “pain message” and treatments such as Anodyne (Anodyne Therapy) have no proven long-term efficacy, according to Dr. Dellon. As he asserts, medication neither prevents nor alters the progressive loss of nerve functioning in those with neuropathy.

    Furthermore, the JAPMA study suggests peripheral nerve decompression may decrease patients’ post-op need for medications. Ninety-nine patients had taken pain medication before surgery while only 22 continued taking the same dose of medication after surgery, according to the study.


    When it comes to treating neuropathy with medication, Dr. Wu says no drug available in the United States would repair the underlying nerve damage and have the effect on balance as the JAPMA study reported of the peripheral nerve decompression. While she notes that alpha lipoic acid has shown promise in treating diabetic peripheral and autonomic neuropathy, Dr. Wu says its affect on proprioception was not assessed during randomized trials.


    However, noting that decompression may not be indicated for all those who have diabetic neuropathy, Dr. Wu cautions DPMs to weigh the risks versus benefits preoperatively and thoroughly review them with the patient. Dr. Dellon notes he does not operate on patients with diabetes unless the diabetes is under control.


    Dr. Wu does not think patients with neuropathy would be reluctant to undergo surgery.


    “In fact, numerous patients inquire about surgical decompression. With technological advances (such as the Internet), patients are more knowledgeable regarding their pathology and treatment options,” explains Dr. Wu. “I have had numerous patients, frustrated with the lack of complete symptomatic relief from their current treatment regimen, inquire about surgical options for their painful diabetic neuropathy.”