Download PDF
Phlebologie 2020; 49(05): 305-316
DOI: 10.1055/a-1238-6657
Originalarbeit

Lipoedema and Pain: What is the role of the psyche? – Results of a pilot study with 150 patients with Lipoedema

Article in several languages: English | deutsch
Gabriele Erbacher
1   Foeldi Clinic Hinterzarten, European Centre for Lymphology
2   Dipl.-Psychologin, Psychologische Psychotherapeutin, Supervisorin (hsi)
,
Tobias Bertsch
1   Foeldi Clinic Hinterzarten, European Centre for Lymphology
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Introduction The present exploratory study is the first so far to investigate the psychological stress in the period before the development of pain symptoms typical for lipoedema.

Methods 150 patients diagnosed with lipoedema syndrome were questioned in semi-structured interviews about psychological stress and were diagnosed with psychological disorders according to ICD-10 criteria. The development of the symptoms typical for lipoedema was recorded in a second interview. Both interviews were blended together in collaboration with the patients, this means Lipoedema-associated pain and psychological stress were related to time.

Result Exactly 80 % of the patients diagnosed with lipedema show a high level of psychological distress immediately before the onset of lipedema-associated symptoms! In this study, mental distress was defined as the presence of a manifest mental disorder (ICD 10 F diagnosis) such as Depression, eating disorder or post-traumatic stress disorder and/or serious psychological distress such as burnout syndrome or chronic stress.

Summary These results contradict a widespread statement that all psychological problems of patients with the diagnosis lipoedema syndrome are caused solely by lipoedema, that lipoedema even causes the patient’s mental disorder.

Moreover, depression and posttraumatic stress disorders are significantly related to the maximum pain intensity estimated by patients in everyday life. This demonstrates that it is imperative to rethink lipoedema therapy and to implement a psychosocial pillar in an overall therapy concept.

Key words

lipoedema - mental stress - mental disease - pain - scientific evidence

Schlüsselwörter

Lipödem - psychische Belastung - psychische Erkrankung - Schmerz - wissenschaftliche Evidenz


Publication History

Article published online:
16 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 S1-Leitlinie Lipödem. Verfügbar unter http://www.awmf.org/uploads/tx_szleitlinien/037–012l_S1_Lipoedem_2016–01.pdf
    Google Scholar
  • 2 Bertsch T, Erbacher G, Corda D. et al Lipödem – Mythen und Fakten Teil 5. Streitschrift für eine European Best Practice of Lipoedema – Zusammenfassung des Konsensus des European Lipoedema-Forums. Phlebologie 2020; 49 (01) 31-50 . doi:10.1055/a-1012-7670
    Article in Thieme ConnectGoogle Scholar
  • 3 Frambach Y, Baumgartner A, Schmeller W. Lipödem und Lebensqualität. Vasomed 2015; 27 (05) 248-249
    Google Scholar
  • 4 Frambach Y, Baumgartner A, Schmeller W. Lipödem – eine „schwere“ Diagnose?. Vasomed 2016; 5: 2-3
    Google Scholar
  • 5 Bullinger M, Kirchberger I. SF-36 Fragebogen zum Gesundheitszustand. Handanweisung. Göttingen: Hogrefe; 1998
    Google Scholar
  • 6 Child AH, Gordon KD, Sharpe P. et al Lipedema: An inherited condition. Am J Med Genet Part A 2010; 152A: 970-976
    CrossrefPubMedGoogle Scholar
  • 7 Dudek JE, Białaszek W, Ostaszewski P. et al Depression and appearance-related distress in functioning with lipedema. Psychology, health & medicine 2018; 23 (07) 846-853 . doi:10.1080/13548506.2018.1459750
    CrossrefPubMedGoogle Scholar
  • 8 Dudek JE, Bialaszek W, Ostaszewski P. Quality of life in women with lipoedema: a contextual behavioral approach. Quality of Life Research 2016; 25: 401-408
    CrossrefPubMedGoogle Scholar
  • 9 Bosman J. Lipoedema: Poor knowledge, neglect or disinterest?. Journal of Lymphoedema 2011; 6 (02) 109-111
    Google Scholar
  • 10 Nath R. The injustice of fat stigma. Bioethics 2019; 33 (05) 577-590 . doi:10.1111/bioe.12560
    CrossrefPubMedGoogle Scholar
  • 11 Fetzer A, Fetzer S. Lipoedema UK big survey 2014 Research Report. Lipoedema UK; 2016 www.lipoedema.co.uk
    Google Scholar
  • 12 Dudek J. Quality of Life and Psychological Functioning of Patients with Lipedema and Dercum’s Disease. FDRS Goals forthe Future, Tools for Today. Salt Lake City: 2017 fatdisorders.org. Abrufbar unter: https://youtu.be/xV-IVc0eVQM
    Google Scholar
  • 13 Alwardat N, Di Renzo L, Alwardat M. et al The effect of lipedema on health-related quality of life and psychological status: a narrative review of the literature [published online ahead of print, 2019 May 6]. Eat Weight Disord 2019; 10 DOI: 1007/s40519-019-00703-x.
    CrossrefGoogle Scholar
  • 14 Kraus RH. Alles über das Lipödem. Lymphologischer Informationsdienst. Abrufbar unter: http://www.lipoedemportal.de/lipoedem-folgeerscheinungen.htm
    Google Scholar
  • 15 Linsmayer D, Neidlinger PK, Braus DF. Rheuma und Psyche – Eine Kurzübersicht. Orthopade 2019; 48 (11) 957-962 . doi:10.1007/s00132-019-03812-8
    CrossrefPubMedGoogle Scholar
  • 16 Baerwald C, Manger B, Hueber A. Depression als Komorbidität bei rheumatoider Arthritis. Z Rheumatol 2019; 78: 243-248 . https://doi.org/10.1007/s00393-018-0568-5
    CrossrefPubMedGoogle Scholar
  • 17 Hofmann P, Hemberger S, Lunzer R. et al Psychische Aspekte der rheumatoiden Arthritis Wie ansprechen? Wie behandeln? Zusammenfassung des Expertenmeetings „Rheuma trifft Psyche“ am 05.11.2015. Abrufbar unter: https://www.pfizermed.at/sites/default/files/rheuma_trifft_psyche.pdf
    Google Scholar
  • 18 Bischoff N, Morina N, Egloff N. Chronischer Schmerz bei Traumatisierung. Komplexität und Herausforderung bei Diagnostik und Therapie. PiD – Psychotherapie im Dialog 2016; 17 (04) 69-72 . doi:10.1055/s-0042-116706
    Article in Thieme ConnectGoogle Scholar
  • 19 Viana MC, Lim CCW, Garcia Pereira F. et al Prior mental disorders and subsequent onset of chronic back or neck pain: findings from 19 countries. J Pain 2018; 19 (01) 99-110 . doi:10.1016/j.jpain.2017.08.011
    CrossrefPubMedGoogle Scholar
  • 20 Tegethoff M, Belardi A, Stalujanis E. et al Comorbidity of Mental Disorders and Chronic Pain: Chronology of Onset in Adolescents of a National Representative Cohort. The Journal of Pain 2015; 16 (10) 1054-1064 . doi:https://doi.org/10.1016/j.jpain.2015.06.009
    CrossrefPubMedGoogle Scholar
  • 21 Hooten WM. Chronic Pain and Mental Health Disorders. 2016 Mayo Foundation for Medical Education and Research, Mayo Clin Proc 2016; 91(7): 955-970. Abrufbar unter: https://www.mayoclinicproceedings.org/article/S0025-6196(16)30182-3/pdf
    Google Scholar
  • 22 Neustadt K, Kaiser U, Sabatowski R. Das biopsychosoziale Schmerzmodell: Leidfaden Heft 2017; 4: 10.13109/9783666402906.49.
    Google Scholar
  • 23 McLaughlin KA, Basu A, Walsh K. et al Childhood Exposure to Violence and Chronic Physical Conditions in a National Sample of US Adolescents. Psychosom Med 2016; 78 (09) 1072-1083 . doi:10.1097/PSY.0000000000000366
    CrossrefPubMedGoogle Scholar
  • 24 Egloff N, Bischoff NS, Kipfer S. et al. Stressinduzierte Hyperalgesie. Ein pathogenetisches Modell zum klinischen Verständnis funktioneller Schmerzsyndrome. Ärztliche Psychotherapie und psychosomatische Medizin 2016; 11 (03) 130-137
    Google Scholar
  • 25 Roth G, Egle UT. Neurobiologie von Schmerz und Stress. Ärztliche Psychotherapie u. Psychosomatische Medizin 2016; 11: 120-129
    Google Scholar
  • 26 Briest J, Bethge M. Der Einfluss von Katastrophisieren auf den Effekt von Depressivität auf Schmerz und körperliche Funktion. Der Schmerz 2017; 2: 159-166
    CrossrefGoogle Scholar
  • 27 Neubauer E, Junge A, Pirron P. et al HKF-R 10 – screening for predicting chronicity in acute low back pain (LBP): a prospective clinical trial. Eur J Pain 2006; 10 (06) 559-566 . doi:10.1016/j.ejpain.2005.08.002
    CrossrefPubMedGoogle Scholar
  • 28 Chibuzor-Hüls J, Casser HR, Birklein F. et al. DNP – Der Neurologe & Psychiater 2020; 21 (02) 54-62
    Crossref
  • 29 Baerwald C. Einfluss von geringem und schwerem Stress auf eine Rheumaerkrankung. Deutsche Rheuma Liga. Abrufbar unter: https://www.rheuma-liga.de/stress
    Google Scholar
  • 30 Häuser W, Bohn D, Kühn-Becker H. et al Is the association of self-reported childhood maltreatments and adult fibromyalgiasyndrome attributable to depression? A case control study. Clin Exp Rheumatol 2012; 74: 59-64
    Google Scholar
  • 31 Afari N, Ahumada SM, Wright LJ. et al Psychological trauma and functionalsomatic syndromes: a systematic review andmeta-analysis. Psychosom Med 2014; 76: 2-11
    CrossrefPubMedGoogle Scholar
  • 32 Blaettler W, Amsler F, Mendoza E. The relative impact on leg symptoms of fears of getting varicose veins and of great saphenous vein reflux. Phlebology 2012; 1-6 DOI: 10.1258/phleb.2012.011158.
    CrossrefPubMedGoogle Scholar
  • 33 Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The past, Present and Future. The Journal of Pain 2015; 16 (09) 807-813
    CrossrefPubMedGoogle Scholar
  • 34 Louw A, Zimney K, Puentedura EJ. et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systemic Review of the literature. Physiother Theory Pract 2016; 32 (05) 332-355
    CrossrefPubMedGoogle Scholar
  • 35 Probst T, Jank R, Nele Dreyer N. et al Early Changes in Pain Acceptance Predict Pain Outcomes in Interdisciplinary Treatment for Chronic Pain. J Clin Med 2019; 8: 1373 . doi:10.3390/jcm8091373
    CrossrefPubMedGoogle Scholar
  • 36 Liedl A, Knaevelsrud C. PTBS und chronische Schmerzen: Entstehung, Aufrechterhaltung und Zusammenhang – Ein Überblick. Schmerz 2008; 22: 644-651 . doi:10.1007/s00482-008-0714-0
    CrossrefPubMedGoogle Scholar
  • 37 Hughes LS, Clark J, Colclough JA. et al Acceptance and Commitment Therapy (ACT) for Chronic Pain: A Systematic Review and Meta-Analyses. Clin J Pain 2017; 33 (06) 552-568 . doi:10.1097/AJP.0000000000000425
    CrossrefPubMedGoogle Scholar
  • 38 Veehof M, Trompetter H, Bohlmeijer E. et al Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behaviour Therapy 2016; 45 (01) 5-31 . doi:10.1080/16506073.2015.1098724
    CrossrefPubMedGoogle Scholar
  • 39 Gerhardt A, Leisner S, Hartmann M. et al Front Psychiatry (Impact factor: 4.58) 2016 [Epub ahead of print]. Eye Movement Desensitization and Reprocessing (EMDR) Versus Treatment as Usual for Non-Specific Chronic Back Pain Patients with Psychological Trauma: A Randomized Controlled Pilot Study.
    Google Scholar
  • 40 Bertsch T, Erbacher G. Lipödem – Mythen und Fakten Teil 1. Phlebologie 2018; 47: 84-92
    Article in Thieme ConnectGoogle Scholar
  • 41 Dilling H, Mombour W. Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F) – Klinisch-diagnostische Leitlinien. Hogrefe; 2015
    Google Scholar
  • 42 Gemeinsame S3-Leitlinie „Diagnostik und Therapie der Essstörungen“, 2. überarbeitete Version Frühjahr 2018. Abrufbar unter: https://www.awmf.org/uploads/tx_szleitlinien/051-026l_S3_Essstoerung-Diagnostik-Therapie_2020-03.pdf
    Google Scholar
  • 43 Jacobi F, Höfler M, Siegert J. et al Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: The Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH). Int J Methods Psychiatr Res 2014; 23 (03) 304-319 . doi:10.1002/mpr
    Google Scholar
  • 44 Dinkel A, Kremsreiter K, Marten-Mittag B. et al Comorbidity of fear of progression and anxiety disorders in cancer patients. Gen Hosp Psychiatry 2014; 36 (06) 613-619 . doi:10.1016/j.genhosppsych.2014.08.006
    CrossrefPubMedGoogle Scholar
  • 45 Schmeller W, Meier-Vollrath I. Das Lipödem: Neue Möglichkeiten der Therapie. Schweiz Med Forum; 2007 7. 151
    Google Scholar
  • 46 Schmeller W, Meier-Vollrath I. Lipedema. Abrufbar unter. https://www.lipedema-simplified.org/downloads/Lipoedema-schmeller.pdf S. 297
    Google Scholar
  • 47 Rapprich S, Dingler A, Podda M. et al Liposuction is an effective treatment for lipedema – results of a study with 25 patients. Journal of the German Society of Dermatology 2011; 9 (01) 33-40 . doi:10.1111/j.1610-0387.2010.07504.x
    PubMedGoogle Scholar
  • 48 Mendoza E. Beitrag als Diskussionsgrundlage zum Thema: Fehlinformation im Internet und Konsequenzen für Patienten und uns Ärzte im täglichen Arbeitsfeld am Beispiel des Lipödems. Phlebologie 2020; 49 (02) 115-116 . doi:10.1055/a-1124-5079
    Article in Thieme ConnectGoogle Scholar
  • 49 Bertsch T, Erbacher G. Lipödem – Mythen und Fakten Teil 2. Phlebologie 2018; 47 (03) 120-126 . doi:10.12687/phleb2418-3-2018
    Article in Thieme ConnectGoogle Scholar
  • 50 Hirsch T, Schleinitz J, Faerber G. Ist die Differentialdiagnostik des Lipödems mittels hochauflösender Sonografie möglich?. Phlebologie 2018; 47: 182-187 . doi:10.12687/phleb2431-4-2018
    Article in Thieme ConnectGoogle Scholar