Cause and management of lipedema‐associated pain

Abstract

Lipedema is a painful, underdiagnosed adipose tissue disorder, characterized by symmetrical swelling of the extremities due to subcutaneous fat deposition in the buttocks, thighs, legs, and arms, sparing the most distal part of the extremities. Although etiology and pathogenesis of lipedema is unclear, possible role of hormonal and genetic factors have been proposed previously. Patients with lipedema suffer from pain, easy bruising, tenderness, and disfigurement. Pain is the leading symptom in lipedema. Since the pain is associated with depression and impaired quality of life, reduction of pain is the major therapeutic approach. Pain in lipedema is attributed to allodynia, exaggerated sympathetic signaling, and estrogens. Although the mechanism of pain in lipedema is uncertain, effective treatment of lipedema should provide a satisfactory pain reduction. Efficacy of the conservative treatment is a matter of debate. Microcannular tumescent liposuction is the most effective therapeutic option for lipedema. There is a large body of evidence that this procedure significantly reduces pain in patients with lipedema.

Lipoedema as a Social Problem. A Scoping Review

“…In the studies selected by the authors, a relationship was observed between mental disorders and the level of perceived pain in patients with lipoedema. Stigmatization, labelling, and downplaying of suffering affects lipoedema patients’ mental states, which makes it difficult to implement effective therapy and increases the level of experienced pain [ 20 , 38 ].…”

Sensory nerves: A driver of the vicious cycle in bone metastasis?

“…Regarding the relationship with SNs, recent studies have revealed that adipose tissue modulates systemic metabolism through secretion of endocrine and paracrine factors such as leptin and TNFα from adipocytes, immune cells and endothelial cells within adipose tissue to local SN fibers to transmit these adipose signals to CNS, which subsequently initiates output to other tissues [115] . Clinical observations that patients with lipedema suffer from pain and that liposuction significantly reduces pain [116] suggest that adipocytes may secrete noxious signals to SNs to evoke pain such as CABP. SN fibers in turn release neurotransmitters such as CGRP and SP to regulate the differentiation and function of adipocytes.…”

Lipedema and lipedematous scalp: An overview

“…Prolonged standing or sitting (as at the end of the day) can also cause discomfort. [3] Exercise or warm weather can precipitate pain. [17] e defining feature of lipedema is a disproportionate distribution of body fat on hips, buttocks, thighs, and lower legs, in a gynoid pattern, producing a disproportion between the upper and lower halves of body.…”

“…[17] e defining feature of lipedema is a disproportionate distribution of body fat on hips, buttocks, thighs, and lower legs, in a gynoid pattern, producing a disproportion between the upper and lower halves of body. [3] Hands and feet are typically spared. e appearance is also known as the "saddle bag phenomenon, " because it mostly affects the hips and thighs while the rest of the body maintains normal proportions.…”

“…[2] e disease affects women, typically manifests at puberty and may worsen during periods of pregnancy or menopause. [3] It is a chronic, painful and progressive disease that can lead to significant disability, impairment of function, and psychological distress. [4] In contrast to obesity, the adipocyte hypertrophy and swelling in lipedema are resistant to dietary modifications and exercise or bariatric surgery.…”