Summary Objective
Our main objective was to determine whether surgical decompression of the lower extremity, in patients suffering from painful diabetic polyneuropathy (painful DPN), would reduce the amount of pain medication taken by patients. Secondary goals were to evaluate the adherence to the recommendations of the Dutch guideline for polyneuropathy (richtlijn Polyneuropathie , 2005) by physicians, and to determine the therapy adherence of patients.
Methods
Prescription data for pain medication were collected from 1-1-2005 up until 1-8-2013 and evaluated for 42 patients, who scored a VAS > 2 and were included in the Lower Extremity Nerve entrapment Study (LENS, NTR 2344). Patients underwent a unilateral nerve decompression of the lower extremity between 2011-2013. Pre operative prescriptions were compared with prescriptions at 3, 6 and 12 months post operative.
Results
Patients showed significantly lower VAS scores after surgical decompression. Six months post operative significantly less medication was used compared to before surgery and 3 months afterwards. Twelve months post operative the results were no longer significant. Of the prescriptions 44% did not meet the recommendations of the Dutch guideline for Polyneuropathy ; for pregabalin this was 29%. Therapy adherence was suboptimal at a Medication Possession Ratio (MPR) < 79%.
Conclusions
Six months after surgical decompression of the nerves in the lower extremity in patients with painful DPN, patients used significantly less pain medication. The Dutch guideline for Polyneuropathy contains incomplete data and needs to be revised. Recommendations of this guideline are only marginally adhered to. Therapy adherence, in patients with painful DPN, regarding pain medication is suboptimal.