Treatments

Treatment

Traditional management of Dercum disease (adiposis dolorosa) has been largely unsatisfactory relying on weight reduction and surgical excision of particularly troublesome lesions. Even at the present time, no known drug can change the course of the disease, and available treatments are only symptomatic.

Nonpharmacological approaches for Dercum disease (adiposis dolorosa) may be used as adjuncts to pharmacologic treatments. Some of these include acupuncture, cognitive behavioral therapy, hypnosis, and biofeedback.

The pharmacological treatments include the following:

• Prednisone, 20 mg daily, has been reported to provide some pain relief. However, in one case, the induction of disease was associated with high-dose corticosteroids.
• Intravenous lidocaine, 400 mg over 15 minutes every other day, has been reported to provide pain relief for 10 hours to several months. The exact mechanism of action is uncertain and remains to be elucidated as to whether it is a central effect or due to its effect on blood flow. Long-term intravenous lidocaine therapy has been associated with neurotoxicity.
• Traditional analgesics, such as nonsteroidal anti-inflammatory drugs, have a poor effect. The lipomas are unresponsive to analgesics, and acetaminophen combined with an opioid analgesic is the first choice. Localized pain may sometimes be treated with a cortisone/anesthetic injection, alternatively with sterile water given intracutaneously or more deeply.

Others medications are as follows:

• Because of troublesome swelling of the fingers, some patients may require diuretics.
• In 2 reported cases of Dercum disease (adiposis dolorosa), interferon (INF) alfa-2b induced long-term relief of pain in 2 patients with adiposis dolorosa and chronic hepatitis C. The analgesic effect of IFN therapy was unexpected and occurred 3 weeks after treatment with 3 million units, 3 times per week, for 6 months. Whether the mechanism of pain relief with IFN is related to its antiviral effect, to the production of endogenous substances (eg, endorphins produced by IFN), or to the interference of INF with interleukin 1 and tumor necrosis factor-alpha cytokine production, which are involved in cutaneous hyperalgesias, remains unclear.
• Two Dercum disease (adiposis dolorosa) case reports have described pain relief with daily intake of oral mexiletine, an antiarrhythmic.
• Singal et al reported improvement of a patient's Dercum disease (adiposis dolorosa) while on infliximab, with and without methotrexate, for ankylosing spondylitis. The patient experienced recurrent weight gain and lipoma pain with discontinuation of these medications.
• Desai et al reported on treatment with a lidocaine (5%) patch, and Lange et al reported on successful therapy with pregabalin with manual lymphatic drainage.

Consultations

• Psychiatrist: Depression and other psychosomatic symptoms are associated with Dercum disease (adiposis dolorosa). Many patients find they are misjudged and require psychological support.
• Rheumatologist: A rheumatologic consultation is warranted to rule out osteoarthritis and fibromyalgia.
• Endocrinologist: An endocrinologic etiology, such as hypothyroidism and Cushing syndrome, should be ruled out.

Diet

Experience shows that lasting weight reduction by changing the diet is difficult to achieve and does not appreciably affect the pain.

Activity

Light physical activity may worsen symptoms because of the stiffness experienced after periods of rest and minimal activity. Patients should avoid monotonous, static work and physical and psychological stress.

The above information is an exerpt from the Adiposis Dolorosa article on Emedicine at http://emedicine.medscape.com/article/1082083-overview

Our Learnings

Can I exercise?

There is a lot of confusion about the whole exercise thing and Dercum's. Is exercise good or bad for you? Should you do it or are you better off not doing it?

Many people have had a reaction to exercise such as increasing lipoma size or increased pain and fatigue after exercising. In general, you should not do STRENUOUS exercise. Less strenuous exercise is fine. Here are some types:

• yoga
• stretching
• water aerobics
• chair aerobics
• walking (if you can - many people can no longer walk long distances without pain)
• jumping on a mini trampoline or rebounder
• cycling (try a recumbent bike for more support)
• swimming

The main thing is LISTEN TO YOUR BODY. Do what you can without causing pain and fatigue. Adjust as you go along. If you can't stand up to do aerobics, switch to chair aerobics. Also, do exercise in 10 minute intervals.  Doing 30 minutes almost everyday is usually what a doctor wants you to try but you can split that up to morning, noon, night or whatever you are comfortable with.  Also, try to mix it up so you are working upper and lower body at different times. 

Exercise helps keep the lymph flowing. It helps your body rid itself of toxins. It's good for you so do what you can.

Of course you should check with your doctor before you start any exercise program!