Treatment and prognosis Adiposis dolorosa

1 treatment , prognosis

1.1 surgery
1.2 medication
1.3 alternative treatment

treatment , prognosis

common treatments dercum s disease directed towards treating individual symptoms. pain relief medication may administered temporarily reduce discomfort in patient. cortisone shots have been shown effective in temporarily reducing chronic pain. surgical removal of damaged adipose tissue can effective, disease recur. once person has dercum s disease have pain rest of life. studies have shown temporary pain relief in patients. long term person dercum s disease need take prescription drugs pain relief ensure quality of life. disease cause chronic , severe pain rest of persons life. there several holistic treatments disease. acupuncture, hypnosis , cognitive behavior therapy have been attempted people dercum s disease.

few convincing large studies on treatment of dercum s disease have been conducted. of different treatment strategies exist based on case reports. currently, there lack of scientific data on use of integrative therapies treatment or prevention of dercum s disease. not enough studies have been done substantiate diet , supplements disease.

treatment methods include following modalities:

surgery

surgical excision of fatty tissue deposits around joints (liposuction) has been used in cases. may temporarily relieve symptoms although recurrences develop.

medication

traditional analgesics

the pain in dercum s disease reported refractory analgesics , non-steroidal anti-inflammatory drugs (nsaids). however, has been contradicted findings of herbst et al. reported pain diminished in 89% of patients (n=89) when treated nsaids , in 97% of patients when treated narcotic analgesics (n=37). dosage required , duration of pain relief not precisely stated in article.

lidocaine

an report 1934 showed intralesional injections of procaine (novocain®) relieved pain in 6 cases. more recently, other types of local treatment of painful sites lidocaine patches (5%) (lidoderm®) or lidocaine/prilocaine (25 mg/25 mg) cream (emla®) have shown reduction of pain in few cases.

in 1980s, treatment intravenous infusions of lidocaine (xylocaine®) in varying doses reported in 9 patients. resulting pain relief lasted 10 hours 12 months. in 5 of cases, lidocaine treatment combined mexiletine (mexitil®), class 1b anti-arrhythmic similar pharmacological properties lidocaine. mechanism lidocaine reduces pain in dercum s disease unclear. may block impulse conduction in peripheral nerves, , thereby disconnect abnormal nervous impulse circuits. nonetheless, might depress cerebral activity lead increased pain thresholds. iwane et al. performed eeg during administration of intravenous lidocaine. eeg showed slow waves appearing 7 minutes after start of infusion , disappearing within 20 minutes after end of infusion. on other hand, pain relief effect greatest @ 20 minutes after end of infusion.

based on this, authors concluded effect of lidocaine on peripheral nerves explains why drug has effect on pain in dercum s disease. in contrast, atkinson et al. have suggested effect on central nervous system more likely, lidocaine can depress consciousness , decrease cerebral metabolism. in addition, skagen et al. demonstrated patient dercum s disease lacked vasoconstrictor response arm , leg lowering, indicated sympathicusmediated local veno-arteriolar reflex absent. suggest increased sympathetic activity. infusion of lidocaine increased blood flow in subcutaneous tissue , normalised vasoconstrictor response when limbs lowered. authors suggested pain relief caused normalisation of up-regulated sympathetic activity.

methotrexate , infliximab

one patient s symptoms improved methotrexate , infliximab. however, in patient dercum s disease, effect of methotrexate discreet. mechanism of action unclear. previously, methotrexate has been shown reduce neuropathic pain caused peripheral nerve injury in study on rats. mechanism in rat study case thought decrease in microglial activation subsequent nerve injury. furthermore, study has shown infliximab reduces neuropathic pain in patients central nervous system sarcoidosis. mechanism thought mediated tumour necrosis factor inhibition.

interferon α-2b

two patients treated interferon α-2b. authors speculated on whether mechanism antiviral effect of drug, production of endogenous substances, such endorphins, or interference production of interleukin-1 , tumour necrosis factor. interleukin-1 , tumour necrosis factor involved in cutaneous hyperalgesia.

corticosteroids

a few patients noted improvement when treated systemic corticosteroids (prednisolone), whereas others experienced worsening of pain. weinberg et al. treated 2 patients juxta-articular dercum s disease intralesional injections of methylprednisolone (depo-medrol). patients experienced dramatic improvement. mechanism pain-reducing ability of corticosteroids in conditions unknown. 1 theory inhibit effects of substances, such histamine, serotonin, bradykinin, , prostaglandins. aetiology of dercum s disease not inflammatory, plausible improvement of patients experience when using corticosteroids not caused anti-inflammatory effect.

alternative treatment

cvac sessions

cyclic variations in adaptive conditioning (cvac) method of touch free cyclic hypobaric pneumatic compression treatment of tissue edema and, therefore, edema-associated pain. pilot study, 10 participants ad completed pain , quality of life questionnaires before , after 20–40 minutes of cvac process daily 5 days. after treatment, there significant decrease in pain measured pain catastrophizing scale , visual analogue scale, there no change in pain quality mcgill pain questionnaire. however, there no changes in pain disability index or pittsburgh sleep quality index. study suggests potential treatment role cvac, , authors recommended randomized controlled clinical trials.