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Specialised treatment

Specialised treatment should be provided by an appropriately qualified lymphoedema practitioner. Such treatments may include:

Manual lymphatic drainage
Studies show that volume reductions are achieved with manual lymphatic drainage. Larger reductions are achieved when this is combined with compression therapy.

Compression therapy
Long-term use of compression bandaging or individually fitted garments is effective in reducing or controlling limb swelling.

Complex physical therapy
Complex physical therapy involves 2–4 weeks of manual lymphatic drainage, followed by compression bandaging, skin care and prescribed exercises. Favourable outcomes have been demonstrated, but some of the evidence is inconsistent and further research is required to define an optimal strategy.

Other treatment options include:

Surgery
Surgery is generally only recommended when conservative treatment options have not been effective.

Pharmacological interventions

  • diuretics are ineffective in lymphoedema
  • some medications may exacerbate the condition (eg antihypertensives, steroids, HRT, anti-inflammatory agents)
  • use of benzopyrones in the management of lymphoedema is not supported by current evidence.

Low level laser therapy and pneumatic pumps
A small number of studies suggest these treatments may be effective in reducing volume. However, further research is required to validate treatment doses and regimes.

Alternative therapies
Research on alternative treatment options is scarce, and some have not been tested on patients with secondary lymphoedema. Such treatments include ultrasound therapy, hyperbaric oxygen therapy, vitamin E supplementation, microwave therapy, acupuncture and moxibustion, mulberry leaf, aromatherapy oils, magnetic fields, vibration and hyperthermia.