Nervous System Dysfunction
It has been suggested that the autonomous nervous system mediates pain in Dercum’s disease. The theory is supported in that, even though the sympathetic nervous system is efferent, sympathectomy sometimes relieves pain in neuropathic pain, where evidence of damage to neural structures exists . This has been explained by the formation of abnormal connections between autonomic and sensory nerves in the periphery and, as a consequence, abnormal autonomic signalling to the spinal column might activate pain fibres. However, in conditions where neural damage cannot be found, the effect on pain might be caused by the placebo response . Moreover, patients with Dercum’s disease could have increased sympathetic activity induced by pain. This theory is supported by a study where a patient with Dercum’s disease did not have any vasoconstrictor response to arm and leg lowering. A normalised vasoconstrictor response could be created by lidocaine infusion that is thought to decrease the local or central sympathetic vasoconstrictor tone . Furthermore, visceral pain may be generated by the autonomic nervous system, and factors that induce visceral pain could also have the ability to induce pain in the adipose tissue. Examples of such factors are anoxemia, formation and accumulation of pain-producing substances, traction or compression of vessels, inflammatory states, and necrosis .
Nonetheless, any substantial evidence of nervous system dysfunction has never been found in Dercum’s disease and is hence merely a theory.
1.Dalziel K: The nervous system and adipose tissue. Clin Dermatol 1989, 7:62–77 2.Furlan AD, Lui PW, Mailis A: Chemical sympathectomy for neuropathic pain: does it work? Case report and systematic literature review. Clin J Pain 2001, 17:327–336. 3.Ochoa JL: Truths, errors, and lies around “reflex sympathetic dystrophy” and “complex regional pain syndrome”. J Neurol 1999, 246:875–879. 4.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. 5.Hansson E, Svensson H, Brorson H: Review of Dercum’s disease and proposal of diagnostic criteria, diagnostic. methods, classification and management Orphanet Journal of Rare Diseases 2012, 7:23 doi:10.1186/1750-1172-7-23