Susceptibility of Nerve in Diabetes to Compression: Implications for Pain Treatment

Twenty-five years ago, it was hypothesized that the peripheral nerve in the patients with diabetes is susceptible to chronic compression. If this hypothesis were true, then decompression of multiple, compressed peripheral nerves, in the patient with diabetic neuropathy, would restore sensation and relieve pain, thereby relieving the traditionally observed clinical course leading to ulceration and amputation. This article reviews research related to this hypothesis and the obtained clinical results. The basic science models necessary to establish the neurophysiological basis proving this hypothesis are reviewed. Translational retrospective and prospective clinical studies related to this hypothesis are reviewed. Implications for therapeutic change and healthcare costs are reviewed. Basic science models demonstrated that the peripheral nerve in diabetes is susceptible to chronic compression. Anatomic studies identified appropriate locations for decompression of nerves in the lower extremity. Clinical outcomes demonstrated significantly decreased ulceration and amputation, significant decrease in admission to hospitals for chronic foot infection, and a significant decrease in pain and increased sensation in patients with diabetes and chronic nerve compression following a Dellon Triple Decompression surgery. The approach described in this review, to identifying chronic nerve compression in the patients with diabetes and subsequent decompression of these nerves, has permitted a significant increase in foot sensibility with the expected decrease in pain and decrease in ulceration and amputation. There is a significant healthcare cost benefit to this approach. At present, this approach is being used in more than 20 countries.