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|Written by NavyDiver1|
|12 September 2011|
SIR, Adiposis dolorosa (Dercum’s disease) is a rare disorder characterized by painful subcutaneous lipomas. Pain treatment with general analgesics often has little or no effect. Weight loss for patients is difficult and there is no guarantee that the lipomas and the pain will disappear even when normal bodyweight is achieved. Surgery may provide temporary pain relief;1 however, the lipomas may recur quickly and surgery is also not without risk. Liposuction, an analogous procedure to surgery, has been reported to be a successful treatment for eliminating
the lipomas and the associated pain.2 Intravenous administration of lidocaine is a nonsurgical treatment.3–5 We report the first case, in a 60-year-old woman, of 15 repetitive successful interventions with intravenous lidocaine to alleviate pain over a period of more than 10 years.
A 50-year-old woman had adiposis dolorosa for 9 years. The
condition had progressed with time, with painful lipomas
appearing all over her body. In addition she was severely
over-weight, hypertensive and had noninsulin dependant diabetes
mellitus. She also developed elevated serum cholesterol
and triglycerides, and nephropathy secondary to her diabetes
mellitus. Lipomas were excised twice, once from the left hip and
once from the left breast, without any reduction of the pain. She
had tried a large number of medications including combined medication consisting of 30mg phenobarbitone and 50mg
caffeine, benzydamine, hydroxyzine chloride, dextropropoxyphene,
nicomorphine, paracetamol, trifluoperazine, amitriptyline
Between January 1986 and October 1996, she was treated
with i.v. lidocaine on 15 occasions. Initially, the infusions
consisted of 200mg lidocaine given over 30 min. She became
pain-free within 30 min and remained so for <4 months. A
slight headache and nausea after the first infusion were the
only side-effects. After four infusions the dose of lidocaine was
increased to 300mg in 30 min. However, after six more infusions,
it was changed again to 300 mg in 1.5 h because the
tenth infusion appeared to be not so effective.
After the second infusion, her oral medication consisted of
50 mg mexiletine three times a day. This treatment relieved her
pain slightly, but failed to suppress it completely. She could not
tolerate an increased dose of mexiletine because of gastrointestinal
Ultimately, she received a lidocaine infusion approximately
once every 6 months which ensured that she remained painfree
for a period of <4 months. If the pain began again, she
used mexiletine at a maximum of 100mg three times a day,
which she could now tolerate, combined with paracetamol.
These reduced the pain, but did not suppress it completely.
In total, she has received 15 lidocaine infusions during the last
Successful treatment of pain in Dercum’s disease by intravenous
administration of lidocaine, with complete pain relief
varying from 10 h to 12 months after treatment, has been
reported in various studies.3–5 Intravenous administration of
lidocaine as a successful painkiller has also been reported in a
number of other disorders, including diabetic neuropathy,
postherpetic neuralgia and injury to peripheral nerves.6–8
The mechanism of analgesia remains unknown both in
Dercum’s disease and other disorders. A central as well as a
peripheral mechanism has been proposed, but no conclusive
evidence for either hypothesis has been obtained to date.3–8
Varying results have been reported after topical application of
a mixture containing lidocaine/prilocaine and local injection of
lidocaine.4,5,9 Mexiletine is an analogue of lidocaine which is
not metabolized so rapidly and therefore can be taken orally.
Complete and long-standing pain relief has been described in
two patients with Dercum’s disease after oral treatment with
mexiletine (200mg three times a day).4 Both patients had
previously responded well to i.v. lidocaine. Mexiletine also has
been reported as a successful analgesic in a number of other
disorders, e.g. diabetic neuropathy and chronic peripheral
neuralgia.10 Our patient used mexiletine in between infusions
and it provided only some pain relief.
As conventional analgesics are often ineffective or only
partially effective in providing pain relief in Dercum’s disease,
the i.v. administration of lidocaine appears to be a relatively safe
and mildly invasive treatment modality. In our opinion, this
treatment modality is preferable to the more invasive methods
such as liposuction and excision, the results of which are
variable and pose a higher risk for the patient.A. C. A. Devillers and A. P. OranjeDepartment of Dermato-venereology,University Hospital Rotterdam,The NetherlandsReferences
1 Held Jl, Andrew JA, Kohn SR. Surgical amelioration of Dercum’sdisease: a report and review. J Dermatol Surg Oncol 1989; 15:
2 Defranzo AJ, Hall Jr JH, Herring SM. Adiposis dolorosa (Dercum’sdisease): liposuction as an effective form of treatment. Plast
Reconstr Surg 1990; 85: 289–92.
3 Iwan T, Maruyama M, Matsuki M et al. Management of intractable
pain in adiposis dolorosa with intravenous administration of
lidocaine. Anesth Analg 1976; 55: 257–9.
4 Petersen P, Kastrup J. Dercum’s disease (adiposis dolorosa). Treatment
of the severe pain with intravenous lidocaine. Pain 1987;
5 Juhlin L. Long-standing pain relief of adiposis dolorosa (Dercum’sdisease) after intravenous infusion of lidocaine. J Am Acad Derm
1986; 15: 383–5.
6 Bach FW, Jensen TS, Kastrup J et al. The effect of intravenous lidocaineon nociceptive processing in diabetic neuropathy. Pain
1990; 40: 29–34.
7 Galer BS, Miller KV, Rowbotham MC. Response to intravenous
lidocaine infusion differs based on clinical diagnosis and site of
nervous system injury. Neurology 1993; 43: 1233–5.
8 Ferrante FM, Paggioli J, Cherukuri S et al. The analgesic response
to intravenous lidocaine in the treatment of neuropathic pain.
Anest Analg 1996; 82: 91–7.
9 Reggiani M, Errani A, Staffa M et al. Is EMLA effective in Dercum’s
disease? Acta Derm Venereol (Stockh) 1996; 76: 170–1.
10 Colclough G, Carter A, Ackerman III WE. Mexiletine for chronic
pain. Lancet 1993; 342: 1484–5.
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