Dercum's Disease Support Group

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

and flunitrazepam.

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

symptoms.

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

10 years.

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.

1 Held Jl, Andrew JA, Kohn SR. Surgical amelioration of Dercum’s

1294–6.

2 Defranzo AJ, Hall Jr JH, Herring SM. Adiposis dolorosa (Dercum’s

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;

28: 77–80.

5 Juhlin L. Long-standing pain relief of adiposis dolorosa (Dercum’s

1986; 15: 383–5.

6 Bach FW, Jensen TS, Kastrup J et al. The effect of intravenous lidocaine

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.