From the Guidelines
If a lipoma on your back is causing pain, you should see a healthcare provider for evaluation and treatment, as pain in a lipoma can occur when it presses against nearby nerves, grows rapidly, or becomes inflamed, and in rare cases, may indicate a more serious condition like liposarcoma. The most common cause of a painful lipoma is compression of nearby nerves or inflammation, but it is essential to rule out other conditions, such as liposarcoma, which is a cancerous tumor. According to the UK guidelines for the management of soft tissue sarcomas 1, the clinical presentation of a sarcoma is often a painless enlarging soft tissue mass, but pain can be a symptom in some cases.
Diagnosis and Evaluation
To evaluate a painful lipoma, your doctor may first try conservative approaches such as over-the-counter pain medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) at standard dosages per package instructions. Imaging studies, such as ultrasound (US) or MRI, may be ordered to confirm the diagnosis and rule out other conditions. US has been shown to be useful in evaluating superficial soft-tissue masses, with high sensitivity and specificity for lipoma 2.
Treatment Options
For surgical removal, the procedure is usually done under local anesthesia on an outpatient basis, with recovery taking a few days to weeks depending on the lipoma's size and location. According to the guidelines for the management of soft tissue sarcomas 3, surgical resection is the usual treatment for atypical lipomatous tumors (ALT), and the prognosis is mostly excellent. However, in some cases, radiological surveillance or adjuvant radiotherapy may be considered.
Important Considerations
It is essential to note that attempting to remove or drain a lipoma yourself can lead to infection or other complications. A healthcare provider should evaluate and treat a painful lipoma to determine the best course of treatment and rule out any underlying conditions. The UK guidelines for the management of soft tissue sarcomas 1 emphasize the importance of early diagnosis and referral to a specialist sarcoma unit if suspected.
Key Points
- Painful lipomas may require removal through minor surgical procedures
- Conservative approaches, such as pain medications, may be tried first
- Imaging studies, such as US or MRI, may be ordered to confirm the diagnosis
- Surgical resection is the usual treatment for ALT, with excellent prognosis
- Attempting to remove or drain a lipoma yourself can lead to complications
From the Research
Causes of Painful Lipoma on the Back
- A painful lipoma on the back can be caused by an episacral lipoma, which occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear 4.
- The presence of a painful nodule with disappearance of pain after injection with anaesthetic is diagnostic of episacral lipoma 4.
- Giant lipomas on the back can also cause pain, as well as difficulties in social life, sleeping, and compressions of nerves or vital structures 5.
- Subcutaneous lipomas can cause musculoskeletal pain and nerve impingement, and can be treated with intralesional injection of triamcinolone acetonide 6.
- Lipomas can affect quality of life, particularly giant lipomas, which can cause problems in daily living and deteriorate quality of life 7.
Characteristics of Painful Lipoma on the Back
- Episacral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest 4.
- Giant lipomas are described as "giant" beyond 1 kg of weight and 10 cm of diameter, and can cause multiple health problems 5.
- Subcutaneous lipomas can be painful and cause symptoms related to impingement or pain with compression of the lipoma 6.
- Intramuscular lipomas in the cervico-cranial area can cause troublesome pain in the neck and occipital area 8.
Treatment Options for Painful Lipoma on the Back
- Local injection of the nodule with a solution of anaesthetic and steroid is effective in treating episacral lipoma 4.
- Intralesional injection of triamcinolone acetonide is an effective and safe alternative to surgical excision or injection of sclerosing agents for painful subcutaneous lipoma 6.
- Surgical excision is indicated for giant lipomas that cause functional impairment or affect quality of life 5, 7.
- Surgical management of intramuscular lipoma in the cervical and cranial area is sometimes indicated, for example, in patients with clinical symptoms or masses with a tendency to grow large 8.