Does nerve decompressive surgery reduce pain for those with Diabetic Peripheral Neuropathy?

Diabetic peripheral neuropathy (DPN) is nerve damage from diabetes that often causes pain, numbness, and weakness in the feet and legs. Nerve decompressive surgery aims to relieve pressure on nerves to reduce these symptoms. While some studies show pain relief, the evidence is not consistent, and the quality of research varies. This answer reviews what the current studies say about whether this surgery helps with pain.

What the research says

A 2024 randomized trial with sham surgery controls found that nerve decompression reduced pain compared to no surgery, but the effect was similar in the sham-operated leg, suggesting a possible placebo effect ⁷. At 12 months, pain scores were lower in decompressed legs than in control legs, but both decompressed and sham legs improved equally ⁷. At 56 months, pain remained lower in decompressed legs compared to controls ⁷. This trial is notable because it used a sham surgery control, which is rare in this field ¹.

A systematic review of randomized controlled trials found that nerve decompressive surgery reduced pain scores at 6 and 12 months compared to no surgery, but the authors noted high risk of bias and wide confidence intervals, limiting confidence in the results ¹. They also highlighted that most trials lacked sham surgery controls and had incomplete outcome data, which could overestimate benefits ¹.

Other studies report more positive outcomes. A 2025 retrospective study of quadruple nerve decompression found significant pain reduction, with VAS scores dropping from 7.31 to 2.51 after about 30 months, and 93.3% of limbs achieving at least 50% pain relief ⁸. Another 2025 trial combining modified decompression with nerve growth factor also showed improvements in pain and nerve function ⁶. However, these studies were not sham-controlled and may be subject to bias ¹.

Overall, the evidence suggests that nerve decompressive surgery may reduce pain in some people with DPN, but the quality of evidence is limited, and results are mixed. The most rigorous trial found no difference between decompressed and sham legs, raising questions about the true benefit beyond placebo ⁷.

What to ask your doctor

• What is my expected benefit from nerve decompressive surgery, given my specific symptoms and nerve damage?
• Are there non-surgical options, such as medications like pregabalin, that I should try first? ⁴
• What are the risks and potential complications of this surgery, and how do they compare to the potential pain relief?
• Is there a sham-controlled trial or other high-quality evidence that supports this surgery for my case?
• How long might the pain relief last, and what happens if the surgery does not help?