Is Flowpresso effective for managing lymphedema?

Flowpresso is Not Recommended for Lymphedema Management Based on Current Guidelines

Flowpresso is not recommended for lymphedema management as it is not mentioned in any established clinical guidelines for lymphedema treatment, which instead recommend evidence-based approaches such as manual lymphatic drainage, compression therapy, and low-level laser therapy.

Current Guideline Recommendations for Lymphedema

According to the Society for Integrative Oncology (SIO) clinical practice guideline endorsed by the American Society of Clinical Oncology (ASCO), the following interventions are recommended for lymphedema management:

• Low-level laser therapy, manual lymphatic drainage, and compression bandaging can be considered for improving lymphedema (Grade C evidence) 1

The American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline recommends:

• Counseling survivors on how to prevent/reduce risk of lymphedema, including weight loss for those who are overweight or obese
• Referring patients with clinical symptoms or swelling suggestive of lymphedema to a therapist knowledgeable about lymphedema diagnosis and treatment, such as a physical therapist, occupational therapist, or lymphedema specialist 1

Evidence-Based Lymphedema Management Approaches

First-Line Treatments

1. Complete Decongestive Therapy (CDT) - The standard of care for lymphedema includes:

   • Manual lymphatic drainage (MLD)
   • Short-stretch compression bandaging
   • Decongestive exercise
   • Skin care
   • Sometimes intermittent pneumatic compression (IPC) 2

2. Physical Activity and Exercise

   • Strength training has been shown to be safe for survivors at risk for or with lymphedema and may even improve lymphedema symptoms
   • Caution is advised, and referral to a lymphedema specialist for evaluation before starting a physical activity program is recommended 1

Special Considerations

For patients with lymphedema who engage in strength training:

• Use of compression garments
• Working with a professional trainer
• Slow progression as tolerated
• Baseline and periodic evaluation of lymphedema 1

Newer Technologies and Approaches

While pneumatic compression devices have shown effectiveness as part of self-care maintenance treatment for lymphedema 3, novel non-pneumatic compression devices have recently demonstrated promising results with greater adherence and patient satisfaction compared to traditional pneumatic devices 3.

Clinical Decision Algorithm

1. Initial Assessment:

   • Identify patients at risk (those who underwent breast surgery, lymph node dissection, radiation)
   • Measure limb volume (>10% difference compared to unaffected limb confirms diagnosis)

2. Treatment Approach:

   • Phase I (Intensive): Complete Decongestive Therapy in clinical setting

     • Manual lymphatic drainage
     • Compression bandaging
     • Exercise
     • Skin care

   • Phase II (Maintenance): Self-management at home

     • Self-lymphatic drainage
     • Compression garments
     • Exercise program
     • Continued skin care

3. For Persistent or Severe Lymphedema:

   • Consider referral to specialized lymphedema clinic
   • Evaluate for advanced therapies including low-level laser therapy

Important Caveats

• Early detection and intervention are critical for preventing progression of lymphedema
• Poor compliance with home care regimens can lead to loss of gains achieved in clinical settings
• Ineffective treatment can result in complications including increased pain, reduced range of motion, increased risk of infection, and psychological sequelae 2
• Lymphedema risk increases over time with a negative impact on quality of life 1

Since Flowpresso is not mentioned in any of the clinical guidelines for lymphedema management, and there are established evidence-based approaches available, it cannot be recommended as a treatment option for lymphedema at this time.