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      Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in adiposis dolorosa

      1 , 2

      Journal of pain research

      Dove Medical Press

      bioimpedance, chronic pain, lipedema

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          Abstract

          Adiposis dolorosa (AD) is a rare disorder of painful nodular subcutaneous fat accompanied by fatigue, difficulty with weight loss, inflammation, increased fluid in adipose tissue (lipedema and lymphedema), and hyperalgesia. Sequential compression relieves lymphedema pain; we therefore hypothesized that whole body cyclic pneumatic hypobaric compression may relieve pain in AD. To avoid exacerbating hyperalgesia, we utilized a touch-free method, which is delivered via a high-performance altitude simulator, the Cyclic Variations in Altitude Conditioning™ (CVAC™) process. As a pilot study, 10 participants with AD completed pain and quality of life questionnaires before and after 20–40 minutes of CVAC process daily for 5 days. Participants lost weight (195.5 ± 17.6–193.8 ± 17.3 lb; P = 0.03), and bioimpedance significantly decreased (510 ± 36–490 ± 38 ohm; P = 0.01). There was a significant decrease in scores on the Pain Catastrophizing Scale ( P = 0.039), in average ( P = 0.002), highest ( P = 0.029), lowest ( P = 0.04), and current pain severity ( P = 0.02) on the Visual Analogue Scale, but there was no change in pain quality by the McGill Pain Questionnaire. There were no significant changes in total and physical SF-36 scores, but the mental score improved significantly ( P = 0.049). There were no changes in the Pain Disability Index or Pittsburgh Sleep Quality Index. These data present a potential, new, noninvasive means of treating pain in AD by whole body pneumatic compression as part of the CVAC process. Although randomized, controlled trials are needed to confirm these data, the CVAC process could potentially help in treating AD pain and other chronic pain disorders.

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          Most cited references 17

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          Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome.

          To enhance the learner's competence in caring for patients with lipedema through understanding the differential diagnoses, pathophysiology, and treatment/management options.
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            The use of bioimpedance analysis to evaluate lymphedema.

            Lymphedema, a chronic disfiguring condition resulting from lymphatic dysfunction or disruption, can be difficult to accurately diagnose and manage. Of particular challenge is identifying the presence of clinically significant limb swelling through simple and noninvasive methods. Many historical and currently used techniques for documenting differences in limb volume, including volume displacement and circumferential measurements, have proven difficult and unreliable. Bioimpedance spectroscopy analysis, a technology that uses resistance to electrical current in comparing the composition of fluid compartments within the body, has been considered as a cost-effective and reproducible alternative for evaluating patients with suspected lymphedema. All patients were recruited through the Beth Israel Deaconess Medical Center Lymphedema Clinic. A total of 15 patients (mean age: 55.2 years) with upper-extremity or lower-extremity lymphedema as documented by lymphoscintigraphy underwent bioimpedance spectroscopy analysis using an Impedimed SFB7 device. Seven healthy medical students and surgical residents (mean age: 26.9 years) were selected to serve as normal controls. All study participants underwent analysis of both limbs, which allowed participants to act as their own controls. The multifrequency bioimpedance device documented impedance values for each limb, with lower values correlating with higher levels of accumulated protein-rich edematous fluid. The average ratio of impedance to current flow of the affected limb to the unaffected limb in lymphedema patients was 0.9 (range: 0.67 to 1.01). In the control group, the average impedance ratio of the participant's dominant limb to their nondominant limb was 0.99 (range: 0.95 to 1.02) (P = 0.01). Bioimpedance spectroscopy can be used as a reliable and accurate tool for documenting the presence of lymphedema in patients with either upper- or lower-extremity swelling. Measurement with the device is quick and simple and results are reproducible among patients. Given significant limitations with other methods of evaluating lymphedema, the use of bioimpedance analysis may aid in the diagnosis of lymphedema and allow for tracking patients over time as they proceed with treatment of their disease.
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              Lymph flow dynamics in exercising human skeletal muscle as detected by scintography.

              1. The effects of dynamic and isometric muscle contractions on the lymph flow dynamics in human skeletal muscle were studied with a scintographic method. 2. Radioactively labelled human serum albumin (99mTc-HSA) was injected bilaterally into the vastus lateralis muscles of eight men (n = 16), four of whom had had an endurance training background. The subjects performed 100 submaximal contractions in 10 min as (i) dynamic knee extensions (CONS), (ii) isometric contractions with the knees at full extension (IMExt), or (iii) isometric contractions with knees fixed at 90 deg angle flexion (IMFlex). The exercises were separated by 65 min periods in supine rest. The level of radioactivity at the injection site was monitored by a gamma-camera, and the clearance rate of radioactivity (CR) was calculated as the fractional decrease during the periods of interest (CR unit = % min-1). 3. The clearance rate was low during the rest periods (0.04 +/- 0.05% min-1), though higher in the trained than in the sedentary subjects (0.06 +/- 0.05 vs. 0.03 +/- 0.03% min-1; P = 0.008). Exercise increased the clearance rate three- to sixfold, to 0.16 +/- 0.16% min-1 during CONS, 0.20 +/- 0.15% min-1 during IMExt and 0.09 +/- 0.11% min-1 during IMFlex. There were no differences between the subject subgroups. 4. The higher clearance rate during IMExt than during IMFlex (P = 0.02) demonstrates the importance of muscle deformations on lymph propulsion and experimentally confirms the current concepts of lymph formation and propulsion in voluntarily active skeletal muscle. It is suggested that lymph propulsion by working muscle is most efficient when the muscle is able to shorten close to its minimum length.
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                Author and article information

                Journal
                J Pain Res
                Journal of Pain Research
                Journal of pain research
                Dove Medical Press
                1178-7090
                2010
                20 August 2010
                : 3
                : 147-153
                Affiliations
                [1 ]Department of Medicine, University of California, San Diego, California, USA;
                [2 ]Department of Psychiatry, University of California, San Diego, California, USA
                Author notes
                Correspondence: Karen L Herbst, 3350 La Jolla Village Dr (111G), San Diego, CA 92161, USA, Tel +1 858-552-8585 (x 7384), Fax +1 858-642-6242, Email karen.herbst@ 123456va.gov
                Article
                jpr-3-147
                10.2147/JPR.S12351
                3004643
                21197318
                © 2010 Herbst and Rutledge, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

                Anesthesiology & Pain management

                bioimpedance, lipedema, chronic pain

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