An early report from 1934 showed that intralesional injections of procaine (Novocain®) relieved pain in six cases . More recently, other types of local treatment of painful sites with lidocaine patches (5%) (Lidoderm®) [2,3] or lidocaine/prilocaine (25 mg/25 mg) cream (EMLA®)  have shown a reduction of pain in a few cases. In the 1980s, treatment with intravenous infusions of lidocaine (Xylocaine®) in varying doses was reported in nine patients [5-12]. The resulting pain relief lasted from 10 hours  to 12 months . In five of the cases, the lidocaine treatment was combined with mexiletine (Mexitil®), which is a class 1B anti-arrhythmic with similar pharmacological properties as lidocaine [7,13,14,12].
The mechanism by which lidocaine reduces pain in Dercum’s disease is unclear. It may block impulse conduction in peripheral nerves , and thereby disconnect abnormal nervous impulse circuits . Nonetheless, it might also depress cerebral activity that could lead to increased pain thresholds . Iwane et al.  performed an EEG during the administration of intravenous lidocaine. The EEG showed slow waves appearing 7 minutes after the start of the infusion and disappearing within 20 minutes after the end of the infusion. On the other hand, the pain relief effect was the greatest at about 20 minutes after the end of the infusion.
Based on this, the authors concluded that the effect of lidocaine on peripheral nerves most likely explains why the drug has an effect on pain in Dercum’s disease. In contrast, Atkinson et al.  have suggested that an effect on the central nervous system is more likely, as lidocaine can depress consciousness and decrease cerebral metabolism . In addition, Skagen et al.  demonstrated that a patient with Dercum’s disease lacked the vasoconstrictor response to arm and leg lowering, which indicated that the sympathicusmediated local veno-arteriolar reflex was absent. This could suggest increased sympathetic activity. An infusion of lidocaine increased blood flow in subcutaneous tissue and normalised the vasoconstrictor response when the limbs were lowered. The authors suggested that the pain relief was caused by a normalisation of up-regulated sympathetic activity.
1. Boller R: Die Novocainbehandling des morbus Dercum. Klinische Wochenschrift 1934, 13:1786–1789.
2. Kosseifi S, Anaya E, Dronovalli G, Leicht S: Dercum’s Disease: An Unusual Presentation. Pain Med 2010, 11:1430–1434.
3. Desai MJ, Siriki R, Wang D: Treatment of Pain in Dercum’s Disease with Lidoderm (Lidocain 5% Patch): A case report. Pain Med 2008, 9:1224–1226.
4. Reggiani M, Errani A, Staffa M, Schianchi S: Is EMLA effective in Dercum’s disease? Acta Derm Venereol 1996, 76:170–171.
5. Iwane T, Maruyama M, Matsuki M, Ito Y, Shimoji K: Management of intractable pain in adiposis dolorosa with intravenous administration of lidocaine. Anesth Analg 1976, 55:257–259.
6. Jensen JJ, Kiilerich S: A case of adiposis dolorosa–Dercum’s disease. Ugeskr Laeger 1991, 153:3564.
7. Steiner J, Schiltz K, Heidenreich F, Weissenborn K: Lipomatosis dolorosa–a frequently overlooked disease picture. Nervenarzt 2002, 73:183–187.
8. Taniguchi A, Okuda H, Mishima Y, Nagata I, Oseko F, Hara M, Otsu A, Kataoka K, Kono T, Imura H: A case of adiposis dolorosa: lipid metabolism and hormone secretion. Int J Obes 1986, 10:277–281.
9. Skagen K, Petersen P, Kastrup J, Norgaard T: The regulation of subcutaneous blood flow in patient with Dercum’s disease. Acta Derm Venereol 1986, 66:337–339.
10. Atkinson RL: Intravenous lidocaine for the treatment of intractable pain of adiposis dolorosa. Int J Obes 1982, 6:351–357.
11. Juhlin L: Long-standing pain relief of adiposis dolorosa (Dercum’s disease) after intravenous infusion of lidocaine. J Am Acad Dermatol 1986, 15:383–385.
12. Petersen P, Kastrup J: Dercum’s disease (adiposis dolorosa). Treatment of the severe pain with intravenous lidocaine. Pain 1987, 28:77–80.
13. Reece PH, Wyatt M, O’Flynn P: Dercum’s disease (adiposis dolorosa). J Laryngol Otol 1999, 113:174–176.
14. Tiesmeier J, Warnecke H, Schuppert F: An uncommon cause of recurrent abdominal pain in a 63-year-old obese woman. Dtsch Med Wochenschr 2006, 131:434–437.