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

Hansson, Emma LU (2011) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2011:77.
Abstract (Swedish)
Popular Abstract in Swedish

Dercums sjukdom är ovanlig sjukdom som kännetecknas av uttalad kronisk smärta (>3 månader) i fettväven, kombinerad med övervikt och ett antal mer diffusa associerade symptom, såsom trötthet och allmän sjukdomskänsla. Orsaken till sjukdomen är okänd. Smärtorna är ofta handikappande och de flesta prövade behandlingar, såsom traditionella smärtstillande, ger otillräcklig effekt på smärtorna. Att ta reda på vad som orsakar Dercums sjukdom samt utveckla nya och förbättrade behandlingar för patienterna är angeläget. Syftet med detta projekt var att undersöka om fettsugning kan ge patienterna smärtlindring samt undersöka orsaken till sjukdomen.

Totalt har 166 kvinnor deltagit i studierna. Av... (More)
Popular Abstract in Swedish

Dercums sjukdom är ovanlig sjukdom som kännetecknas av uttalad kronisk smärta (>3 månader) i fettväven, kombinerad med övervikt och ett antal mer diffusa associerade symptom, såsom trötthet och allmän sjukdomskänsla. Orsaken till sjukdomen är okänd. Smärtorna är ofta handikappande och de flesta prövade behandlingar, såsom traditionella smärtstillande, ger otillräcklig effekt på smärtorna. Att ta reda på vad som orsakar Dercums sjukdom samt utveckla nya och förbättrade behandlingar för patienterna är angeläget. Syftet med detta projekt var att undersöka om fettsugning kan ge patienterna smärtlindring samt undersöka orsaken till sjukdomen.

Totalt har 166 kvinnor deltagit i studierna. Av dessa hade 114 Dercums sjukdom och 41 var friska överviktiga kontrollpatienter och 11 friska normalviktiga kontroller. Femtiotvå av Dercumpatienterna behandlades med fettsugning på de mest smärtsamma områdena. Övriga Dercumpatienter var sjuka kontroller.

I det första delprojektet visades att patienternas vibrations- och temperaturkänsel inte förändras efter fettsugning. I det andra delprojektet visades att Dercumpatienternas smärtor minskades av fettsugningen, men att det är oklart om smärtlindringen beror på själva fettsugningen eller på andra faktorer. I det tredje delprojektet visades att koncentrationen av neuropeptider, ämnen som bildas i nervsystemet och som fungerar som signalmolekyler inte är förändrad i hjärn-ryggmärgsvätskan eller i blodet, vid Dercums sjukdom. Förändrade neuropeptidkoncentrationer har tidigare setts vid vissa andra smärtsjukdomar. I det fjärde delprojektet visades att Dercumpatienterna inte har ökad inflammation i sin fettväv.

Tillsammans har dessa studier visat att fettsugning skulle kunna vara ett behandlingsalternativ vid Dercums sjukdom, men att fler studier behövs innan metoden kan användas som standardbehandling. Dessutom har vi visat att patienterna inte har förändrad neuropeptidkoncentration eller förhöjd inflammation i sin fettväv. Detta talar emot att en förändrad neuropeptidkoncentration eller en inflammatorisk reaktion kan förklara patienternas smärtor. (Less)
Abstract
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Md, PhD Nisell, Ralph, Karolinska Institutet, Stockholm
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Dercum's disease, Liposuction, Plastic surgery, Chronic pain, Sensitivity, Neuropeptides, Adipose tissue histology
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2011:77
pages
183 pages
publisher
Department of Plastic and Reconstructive Surgery, Malmö University Hospital, Malmö, Sweden,
defense location
Medicinska klinikens aula, ingång 35, SUS Malmö
defense date
2011-10-20 13:15
ISSN
1652-8220
ISBN
978-91-86871-27-7
language
English
LU publication?
yes
id
4b5f11ab-4bcc-4072-bc9d-66cd637bc03b (old id 2158759)
date added to LUP
2011-09-21 09:11:05
date last changed
2016-09-19 08:44:48
@phdthesis{4b5f11ab-4bcc-4072-bc9d-66cd637bc03b,
  abstract     = {Dercum’s disease is a rare condition characterised by obesity, chronic pain (&gt;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. <br/><br>
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.<br/><br>
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. <br/><br>
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. <br/><br>
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.},
  author       = {Hansson, Emma},
  isbn         = {978-91-86871-27-7},
  issn         = {1652-8220},
  keyword      = {Dercum's disease,Liposuction,Plastic surgery,Chronic pain,Sensitivity,Neuropeptides,Adipose tissue histology},
  language     = {eng},
  pages        = {183},
  publisher    = {Department of Plastic and Reconstructive Surgery, Malmö University Hospital, Malmö, Sweden,},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Liposuction in Dercum's disease. Clinical studies regarding Dercum's disease and the effect of liposuction.},
  volume       = {2011:77},
  year         = {2011},
}