Recognizing fibromyalgia-like pain phenotypes in lipedema: A narrative review

Introduction Lipedema is a chronic adipose and connective tissue disorder in which pain is classically localized to affected limb tissue. However, some patients report joint, periarticular, myotendinous, or axial pain, with fatigue, sleep disturbance, and exercise intolerance. When symptoms become widespread, the presentation may resemble fibromyalgia (FM), creating a diagnostic challenge for phlebologists. Objectives To provide a clinical framework for distinguishing characteristic lipedema tissue pain from musculoskeletal pain generators, secondary central pain amplification, and potentially coexisting FM. Methods This narrative review was conducted with reference to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed, Scopus, and Google Scholar were searched through May 2026 for studies addressing lipedema, FM, widespread pain, hypermobility, connective tissue vulnerability, biomechanical dysfunction, and pain sensitization. Reference lists were manually screened. No formal risk-of-bias assessment or quantitative synthesis was performed. Results Characteristic lipedema pain is predominantly localized to affected adipose tissue and associated with tenderness, pressure sensitivity, easy bruising, and functional impairment. Observational studies have also reported joint and periarticular pain, axial symptoms, hypermobility, and biomechanical dysfunction in patient subsets. Extra-adipose pain should be assessed separately and not automatically attributed either to lipedema or independent FM. Tissue hypersensitivity, stromal and microvascular alterations, joint instability, and altered biomechanics may represent peripheral pain generators contributing to secondary central amplification. However, observational evidence does not establish whether widespread pain is intrinsic to lipedema, secondary to musculoskeletal dysfunction or central amplification, or reflects coexisting FM. Conclusions In patients with lipedema and extra-adipose or widespread pain, phlebologists should assess joint hypermobility, instability, biomechanical dysfunction, and axial or musculoskeletal pain. FM criteria identify a widespread pain phenotype but cannot determine whether it represents an independent comorbidity or is related to persistent peripheral nociceptive mechanisms. Multidisciplinary assessment may improve diagnostic characterization and individualized management.