What is the treatment for lymphedema?

Treatment of Lymphedema

The standard of care for lymphedema is Complete Decongestive Therapy (CDT), which includes manual lymphatic drainage, compression therapy, therapeutic exercises, and skin care. 1 This comprehensive approach is essential for reducing limb volume and preventing complications that can significantly impact quality of life.

Components of Lymphedema Treatment

Phase 1: Intensive Treatment

• Manual Lymphatic Drainage (MLD):

  • Specialized massage technique performed by trained therapists
  • Stimulates lymphatic flow and redirects fluid to functioning lymphatic vessels
  • Particularly beneficial for patients with sensitivity to compression bandaging 2

• Compression Therapy:

  • Short-stretch compression bandaging applied in layers
  • Provides graduated pressure to facilitate lymph flow
  • Evidence suggests MLD and compression bandaging are equally effective treatment options 2

• Therapeutic Exercises:

  • Activates muscle pumping to enhance lymphatic drainage
  • Improves joint mobility and prevents stiffness
  • Should be performed while wearing compression garments 3

• Skin and Nail Care:

  • Prevents infections (particularly erysipelas and lymphangitis)
  • Includes daily hygiene and moisturizing to maintain skin integrity 4

Phase 2: Maintenance Treatment

• Self-management with compression garments during daytime
• Nighttime compression with bandaging or specialized devices
• Self-MLD or use of mechanical devices for lymphatic drainage
• Continued exercise and skin care regimen 3, 5

Treatment Effectiveness

CDT can achieve a 32-43% reduction in limb volume during the intensive phase 1. However, it's important to note that lymphedema treatment rarely provides a complete cure and typically requires lifelong management to maintain results and prevent complications 4.

Special Considerations

• Infection prevention is critical as lymphedema increases infection risk
• Weight management should be emphasized as obesity can worsen lymphedema
• Progressive resistance training appears safe and may actually reduce lymphedema risk in high-risk patients 1
• Regular assessment of limb volume and symptoms is necessary to evaluate treatment effectiveness

Common Pitfalls to Avoid

1. Inadequate compression: The most important component of treatment is compression therapy - lymphedema can improve with bandaging alone, but sustained improvement cannot be achieved without proper compression 4

2. Poor transition from Phase 1 to Phase 2: Many patients struggle with the transition to self-management, leading to loss of gains achieved in the clinic 5

3. Neglecting skin care: Infections can significantly worsen lymphedema and lead to additional complications

4. Discontinuing treatment: Lymphedema requires ongoing management as there is no definitive cure 1

For patients with breast cancer-related lymphedema, it's important to note that once established, lymphedema should be treated by trained therapists using a combination of compression bandaging, manual lymphatic drainage, and graduated compression garments 2.