Liposuction in Dercum's disease. Clinical studies regarding Dercum's disease and the effect of liposuction

Sammanfattning: Dercum’s disease is a rare condition characterised by obesity, chronic pain (>3 months) in the adipose tissue and a number of diffuse associated symptoms, such as fatigue and malaise. The aetiology of the disease is unknown. The experienced pains are often disabling and resistant to most tried treatments, such as analgesics. However, a number of case reports have been published on the promising effect of liposuction.
The aims of this study were to investigate the effect of liposuction on thermal and sensory sensation, to examine the effect of liposuction on the pain experienced by patients, to examine neuropeptide levels in cerebrospinal fluid and plasma, and to investigate the inflammatory signs in adipose tissue of patients with Dercum’s disease.
A total of 111 patients with Dercum’s disease were recruited to the study. The first 53 patients were operated on with liposuction and the following 58 patients were un-operated controls. In addition, 41 healthy obese women and 11 normal weight healthy women were recruited as different control groups. The patients and controls were followed for five years. Not all groups were included in every study.
In study I, vibratory and thermal thresholds were determined preoperatively and after liposuction in women with Dercum’s disease. The results showed that there were only small differences in sensation postoperatively, as compared with preoperatively, and none of these were statistically significant. In study II, pain was measured in patients and in controls. The study indicated that liposuction might alleviate pain in patients with Dercum’s disease. However, it is difficult to determine whether the effect was due to the actual surgery or to other factors. In paper III, neuropeptides were measured in cerebrospinal fluid and in plasma from patients and controls. The results showed that altered levels of neuropeptides that have previously been seen in different pain conditions cannot clearly be demonstrated in Dercum’s disease. In paper IV, adipose tissue biopsies were obtained by surgical biopsy from all patients and controls. The results revealed that there was an inflammatory response in the adipose tissue of patients with Dercum’s disease. However, the response was not more pronounced than in healthy obese controls.
Collectively, we demonstrated that liposuction cannot yet be recommended as the standard treatment for Dercum’s disease. Furthermore, we showed that neuropeptide levels seem to be normal and that the aetiology of the disease might not be inflammatory.