Adiposis Dolorosa (Dercum's Disease)

Adiposis Dolorosa (Dercum’s Disease) – Treatment Options

Introduction
Adiposis dolorosa, also known as Dercum’s disease, is a rare chronic disorder characterized by painful subcutaneous lipomas, typically located on the trunk and extremities. It most commonly affects obese, middle-aged women and is often associated with fatigue, weakness, emotional disturbances (depression, anxiety), and cognitive impairment (“brain fog”). The pathophysiology is poorly understood, involving adipose tissue dysfunction, nervous system abnormalities, and possible autoimmune mechanisms. There is no definitive cure; treatment focuses on symptom relief, improving quality of life, and managing comorbidities.

---

1. General and Supportive Measures

• Lifestyle modifications:

  • Weight management may improve symptoms but does not eliminate lipomas.

  • Regular low-impact exercise (walking, swimming, cycling) to enhance mobility.

• Psychological support:

  • Counseling or cognitive-behavioral therapy (CBT) to address depression, anxiety, and chronic pain coping.

• Patient education:

  • Emphasize the chronic, non-malignant nature of the disease while validating pain complaints.

---

2. Pharmacologic Therapy (Symptom-Oriented)

• Analgesics:

  • NSAIDs (ibuprofen, naproxen) for mild pain.

  • Opioids for severe, refractory pain (used cautiously due to dependence risk).

• Neuropathic pain medications:

  • Gabapentin, pregabalin, duloxetine, or amitriptyline for nerve-related pain.

• Corticosteroids:

  • Occasionally used (systemic or local injections) for temporary symptom relief.

• Lidocaine therapy:

  • IV lidocaine infusions or topical/transdermal lidocaine patches have shown benefit in pain reduction.

---

3. Interventional and Surgical Options

• Liposuction:

  • Can reduce lipoma burden and pain, though recurrence is common.

  • May improve mobility and quality of life.

• Surgical excision of lipomas:

  • Reserved for localized, particularly painful lipomas.

  • Limited by potential for new lipoma formation elsewhere.

• Nerve blocks or neurostimulation (experimental):

  • Considered in patients with severe neuropathic pain unresponsive to medications.

---

4. Complementary and Experimental Approaches

• Manual therapies: Lymphatic drainage, massage, and acupuncture may provide temporary relief in some patients.

• Biologic and immunomodulatory therapy (research stage): Possible role in selected cases if autoimmune involvement confirmed.

• Psychiatric/psychological interventions: Address chronic pain syndrome overlap and mood disorders.

---

5. Monitoring and Long-Term Care

• Pain monitoring: Regular assessment using standardized pain scales.

• Functional evaluation: Tracking mobility, daily activity performance, and work capability.

• Metabolic and endocrine screening: For obesity, diabetes, thyroid dysfunction, and metabolic syndrome.

• Quality-of-life follow-up: Focused on emotional well-being and fatigue management.

---

6. Multidisciplinary Care

• Primary care physicians: Coordination of ongoing management.

• Pain specialists: For advanced pain management strategies.

• Endocrinologists: For weight and metabolic disorder management.

• Plastic/General surgeons: For surgical excision or liposuction of lipomas.

• Psychologists/psychiatrists: For mental health and coping strategies.

• Physiotherapists/rehabilitation specialists: For mobility and physical support.