For years, clinicians have faced a frustrating evidence gap: short-term data suggested that lower extremity nerve decompression (LEND) could meaningfully reduce pain in selected patients with painful diabetic peripheral neuropathy (PDPN) — but no one knew if those gains actually lasted. The longest prior follow-up in the literature was just 52 months.
A landmark new cohort study published in Neurology & Therapy now provides what the field has been waiting for: real-world outcome data stretching more than a decade — and the results are ones every clinician treating PDPN should read for themselves.
What This Study Examined
Researchers at Shanghai JiaoTong University School of Medicine followed patients with PDPN originally treated between 2008 and 2011 — comparing those who underwent LEND surgery against those managed with conventional analgesic therapy alone. With a median follow-up exceeding 13 years, this is among the longest real-world outcome studies ever conducted on a surgical intervention for painful diabetic neuropathy.
Beyond pain intensity, the study measured functional interference, psychological outcomes, analgesic medication burden, and a long-term complication outcome that carries serious implications for diabetic patient care. The full methodology, outcome tables, Kaplan-Meier analyses, and prognostic factor data are all available in the complete manuscript.
A Few Things the Data Revealed
We won't spoil all of it here — that's what the download is for. But here is enough to tell you why this study deserves your attention:
- The difference in meaningful pain response rates between the surgical and medical groups after 13+ years was not subtle.
- The surgical benefit observed at 2 years did not erode over time — and the trajectory of the medical group moved in the opposite direction.
- A specific long-term complication common in diabetic patients showed a dramatic difference in cumulative incidence between the two groups.
- The study identifies which patients responded best — findings that have direct implications for how and when to consider surgical referral.
- Contrary to what some clinicians assume, one particular patient subgroup that is often excluded from surgical consideration showed outcomes that may surprise you.
Who Should Download This Study
This manuscript is directly relevant to neurosurgeons, neurologists, endocrinologists, diabetologists, pain medicine specialists, vascular surgeons, and podiatric physicians who manage patients with refractory painful diabetic peripheral neuropathy — particularly those navigating the decision of when, and for whom, to consider surgical intervention.
The full study — including all data tables, figures, subgroup analyses, and the authors' clinical recommendations — is available as a free PDF download. Complete the brief form below for immediate access.
About the Study
This study was authored by Chenlong Liao, Shuo Li, Wenxiang Zhong, Yayuan Tian, and Wenchuan Zhang of Shanghai Ninth People's Hospital and Xinhua Hospital, affiliated with Shanghai JiaoTong University School of Medicine. It was published online March 12, 2026 in Neurology & Therapy (Adis / Springer Nature), DOI: 10.1007/s40120-026-00913-3, under a Creative Commons Attribution-NonCommercial 4.0 International License.
