ketogenic diet

Pain in Lipedema: Causes and Management

By March 10, 2022 March 17th, 2022 No Comments

Let’s explore a paper called Cause and Management of Lipedema-Associated Pain by a group of physicians, including Dr. Uwe Wollina, at a teaching hospital in Dresden, Germany today. This article was published in the medical journal Dermatologic Therapy in the January/February issue in 2021.  

This review article discusses the pain experienced by women with lipedema and some ways to manage and treat them. 

Pain in Lipedema

The authors state that based on their clinical observations and imaging, they believe that the pain in lipedema is:

  • not associated with lymphedema or edema
  • is not related to the stage of lipedema
  • has different qualities and possibly different causes
  • maybe different in intensity and quality between the affected body parts, and
  • may overlap with orthopedic or arthritis-associated pain

They believe that the causes of pain in lipedema are attributed to allodynia, exaggerated sympathetic signaling, and interestingly, estrogens. Let me explain each of these.

Allodynia, exaggerated sympathetic signaling, and estrogens

Allodynia is severe pain in response to mild trauma or pressure to the affected area. The exaggerated sympathetic signaling may be partly responsible for this. When the wires get crossed in the sympathetic nervous system, we can have that amplified pain response. The authors believe that this exaggerated sympathetic signaling may be due to hypoxia or low oxygen in the tissues, inflammation, and dead or dying fat cells.

Lastly, estrogens may decrease pain as is noted in fibromyalgia where there is often an associated estrogen dysfunction. There is a belief that estrogen is somehow involved in lipedema, but we don’t yet know-how. The authors state that none of these possible origins of lipedema pain have been confirmed. 

Treatment Options 

According to the authors, some of the viable treatment options for lipedema include Complete Decongestive Therapy, which is manual lymph drainage, compression therapy, and gentle exercise. Compression therapy may include compression bandaging, compression garments, or a pneumatic pump. The exercises suggested in the article include walking, swimming, aerobics, or Pilates.

“A non-inflammatory, ketogenic and carbohydrate-limited” diet is recommended. Interestingly, they don’t believe this way will reduce lipedema fat but it seems to be effective for decreasing pain. We clearly need a clinical trial to test this!

Lastly, the authors believe that the only proven method to both remove lipedema fat and to effectively reduce pain is liposuction, although they acknowledge that the mechanism for this effect is not known and more study is needed.


This review article is important for the lipedema community as it provides more information about the pain experienced by women with lipedema. I believe, however, that we may find that conservative measures may be just as effective at managing lipedema and its associated pain, and in many cases, liposuction surgery won’t be needed. 

For more related content, be sure to check out Lipedema Simplified’s Flash Briefings, our daily mini-podcast with tips, tools, helpful research, and other resources pertaining to lipedema.


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