Treatment of Pain in Dercum's Disease with Lidoderm® (Lidocaine 5% Patch): A Case Report

Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidencebased data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.

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“…Many individuals with DD obtain good local pain relief using lidocaine patches, cream, gel or EMLA [248,254] .…”

Section: Dd Treatment Recommendationsmentioning

confidence: 99%

“…(c) Lidocaine: Intravenous (IV) lidocaine has been used with some success to treat the intractable pain associated with DD [217,[247][248][249][250][251][252][253] . Many individuals with DD obtain good local pain relief using lidocaine patches, cream, gel or EMLA [248,254] .…”

Section: Dd Treatment Recommendationsmentioning

confidence: 99%

Rare adipose disorders (RADs) masquerading as obesity

2012

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“…Diagnosis is on based triad of painful plaques, ecchymoses and obesity appearing in women with amenorrhoea and neurotic symptoms. Weight reduction, surgical excision and lidocaine can be considered [4].…”

Section: Discussionmentioning

confidence: 99%

Dercums Disease/Adiposis Dolorosa

Rasheed¹

2017

Pigmentary Disorders

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“…Current treatments for AD include surgical excision or liposuction,5–7 intravenous lidocaine,8 topical analgesics,9,10 infliximab and methotrexate,11 and pregabalin combined with manual lymphatic drainage therapy 12. Intravenous lidocaine is not effective for many patients with AD; topical analgesics provide modest relief; and the immunosuppressive combination of infliximab and methotrexate risks complications, such as infection, and has only shown benefit in a single case to date.…”

Section: Introductionmentioning

confidence: 99%

Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in adiposis dolorosa

Herbst

Rutledge²

2010

JPR

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Adiposis dolorosa (AD) is a rare disorder of painful nodular subcutaneous fat accompanied by fatigue, difficulty with weight loss, inflammation, increased fluid in adipose tissue (lipedema and lymphedema), and hyperalgesia. Sequential compression relieves lymphedema pain; we therefore hypothesized that whole body cyclic pneumatic hypobaric compression may relieve pain in AD. To avoid exacerbating hyperalgesia, we utilized a touch-free method, which is delivered via a high-performance altitude simulator, the Cyclic Variations in Altitude Conditioning™ (CVAC™) process. As a pilot study, 10 participants with AD completed pain and quality of life questionnaires before and after 20–40 minutes of CVAC process daily for 5 days. Participants lost weight (195.5 ± 17.6–193.8 ± 17.3 lb; P = 0.03), and bioimpedance significantly decreased (510 ± 36–490 ± 38 ohm; P = 0.01). There was a significant decrease in scores on the Pain Catastrophizing Scale (P = 0.039), in average (P = 0.002), highest (P = 0.029), lowest (P = 0.04), and current pain severity (P = 0.02) on the Visual Analogue Scale, but there was no change in pain quality by the McGill Pain Questionnaire. There were no significant changes in total and physical SF-36 scores, but the mental score improved significantly (P = 0.049). There were no changes in the Pain Disability Index or Pittsburgh Sleep Quality Index. These data present a potential, new, noninvasive means of treating pain in AD by whole body pneumatic compression as part of the CVAC process. Although randomized, controlled trials are needed to confirm these data, the CVAC process could potentially help in treating AD pain and other chronic pain disorders.

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Treatment of Pain in Dercum's Disease with Lidoderm® (Lidocaine 5% Patch): A Case Report

Cited by 22 publications

References 19 publications

Rare adipose disorders (RADs) masquerading as obesity

Rare adipose disorders (RADs) masquerading as obesity

Dercums Disease/Adiposis Dolorosa

Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in adiposis dolorosa

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