Pharmacologic Pain Treatment for Adiposis Dolorosa: A Case Report

Abstract

Dercum’s disease, also known as adiposis dolorosa, is a rare pain syndrome caused by one or more painful lipomas. We present an educational case of Dercum’s disease resulting in debilitating pain. An 80-year-old male developed multiple painful lipomas within a span of 24 months. The patient underwent surgical excision of the larger lipomas on the anterior thorax and thoracolumbar region, but continued to complain of diffuse pain. The pain at the post-resection sites was consistent with nociceptive-related pain from acute surgical intervention, but he also continued to complain of burning, neuropathiclike pain in the surrounding areas of the lipomas. The patient received minimal benefits from nonsteroidal anti-inflammatory drugs (NSAIDs) and adjuvant therapy, including neuromodulating agents. The patient was started on progressively larger doses of oral opioids which resulted in no relief. The medical regimen was changed to transdermal fentanyl and monitored closely by the pain management physician. Fentanyl was used to capitalize on the highly lipophilic nature of this medication, which was hypothesized to address the fatty tumor-related pain. The patient reported pain reduction of more than 50% and thus was able to continue activities of daily living with an improved quality of life. Key words: Adiposis dolorosa, Dercum’s disease, lipoma, lipophilic, opioid, pain management