This survey about the short- and long-term results of pneumatic pump use in lymphedema cases was conducted within the Greater Boston Lymphedema Support Group in the spring of 1997. It includes a few cases in neighboring states.
The survey consisted of calling or trying to contact by mail the first 133 members of the group in the order of their signing up for our mailing list. No additional members were called after the first 100 persons had been interviewed. One additional person contacted us by herself. 28 members did not return our calls or didn't respond to a mailing. Unfortunately, four members had died recently.
Thus, our sample group consists of 101 members. On account of the growth of our support group through connections to breast cancer support groups, breast care centers and medical fitting services, our membership is most likely over-represented in its cases of secondary arm lymphedema.
|Brand of pneumatic pump used||No. of members|
|Lymphapress, various models||26|
|Jobst, one and more chambers||9|
|Biocompression, Sequential Circulator||7|
|Duration of pump use||No. of members|
|10 - 20 years||4|
|5 - 10 years||6|
|1 - 5 years||11|
|.5 - 1 year||12|
|3 - 6 months||9|
|less than 3 months||11|
|Pressure setting in mm Hg||No. of members|
|25 - 35||3|
|35 - 40||2|
|40 - 50||5|
|50 - 75||9|
|75 - 100||8|
|100 - 120||2|
|As high as possible||6|
|As painful as could be tolerated||1|
|Reduction of limb size||No. of members|
|No reduction in size of limb, "pump doing nothing"||13|
|Some reduction initially, "Not helping anymore"||7|
|"Always use it before being fitted for new pair of support stockings"||1|
|No. of members|
|Pain or pressure lessened||5|
|Skin after pumping better, softer||3|
|No. of members|
|Limb showed increased swelling||2|
|Swelling pushed into back, thigh, abdomen, upper arm, chest or hand||8|
|"Made swelling worse under arm and side of breast"||1|
|More pain, soreness, feeling bruised||9|
|Cellulitis, infection in limb||2|
|"Hand got worse"||1|
|"Leg turns ice cold and numb"||1|
|"Lack of function in arm"||1|
|"Caused leaking in groin"||1|
|"Fibrosis in forearm may be due to pumping"||1|
|"My foot got sore, at the end of scar very sore and red"||1|
|No. of members|
|Too time-consuming, "Hated sitting there"||5|
|"Isolated me because pump is too noisy"||1|
|"Didn't like being hooked / married to it"||1|
|No. of members|
|"Doctor saw that it didn't do what he expected"||1|
|"Doctor recommended not to use pump anymore"||1|
|"Dr. Slavin said pump (one chamber) was useless"||1|
|"Pump didn't do more than elevating legs at night"||1|
|"Stopped pumping when I started swimming regularly"||1|
|"Reading (about effects of pump) in literature made me nervous"||1|
|"Sleeve didn't fit right"||1|
|"Heard that liquid had no place to go"||1|
|Information from National Lymphedema Network||2|
|Heard from other LSG members about possible damage||2|
|Negative impact on lifestyle||7|
|Negative effects caused by pumping||22|
|Duration of usage||No. of members||Members still using pump||Members reporting damage|
|10 to 20 years||4||3||1|
|5 to 10 years||6||1||2|
|1 to 5 years||11||3||3|
|.5 to 1 year||12||2||4|
|3 to 6 months||9||0||6|
|Less than 3 months||11||1||4|
|Duration not stated or remembered||3|
Quite a number of members have tried a pump for less than a year. Of these only 3 are still using a pump and 14 reported damages. On the other hand, in the group that has used a pump for more than a year 7 members are continuing to use a pump and proportionally less damages were reported.
Four members are offering their pumps for sale, one member is looking for a pump.
Pumps still being used:
|Biocompression/ Sequential Circulator||2|
|Huntleigh Flowtron (3 chambers)||2|
|Jobst (3 chambers)||1|
This distribution of brands more or less mirrors the distribution of pump brands in the overall sample (see table 2).
Three of the continuing pump users, all with primary lymphedema and all using a Lymphapress, have used their pump for 10 years or more. However, one of these members uses the pump only sporadically before being fitted for the next pair of compression stockings. The other used to pump at 75 - 100 mm Hg but is now pumping at 50 mm Hg. She used to pump daily, 2 hours a day. Initially it helped with the pressure, made her legs feel less tired. Two years ago the legs got worse. She is now pumping 3 times a week but has no major reduction. The third member was told to pump at a pressure setting as high as she could stand it. She pumped during the first year twice daily for 1 - 2 hours. Her leg went down but only temporarily. Now she pumps about once a month and the pumping shows less results.
Three of the continuing pump users have used their pump from 2 to 5 years. One uses her pump at the low setting of 25 mm Hg, once in a while to 2 or 3 times a week. Another one uses it at 40 to 45 mm Hg 4 to 5 times a week, 1 to 5 hours per night, with good results. Her arms are nearly equal in size. The third one used to use the pump at first every night, at 70 - 80 mm Hg, uses it now only when leg hurts, for ½ to 1 hour. The leg doesn't go down as much anymore, but the pumping still helps to relieve the pressure. The fourth one has used the pump since summer 1995. Using it for one hour brings the arm down. If she uses the pump every day, half an hour of pumping is enough to bring it down. Her arm is slimmer.
The remaining three continuing pump users have started to use a pump only recently: November 1996, October 1996 and February 1997. One has used it at 40 mm Hg, in conjunction with treatments by a Physical Therapist. She has not used it often, but expects to use it more during the hot weather. Pumping results in reduction in size and softer skin. The second one had used the pump for only one month, 5 times a week, 2 hours a day. The oncologist recommended a pressure of 40 mm Hg, the fitter recommended 50 mm Hg. The pumping reduced her arm by one size regarding her compression sleeve. The last one was advised to pump at 100 mm Hg. He is pumping daily, 3 to 4 hours a day. He has very good results, reduced volume, better skin condition and less pain.
This survey is far from being a rigorous study. The number of patients who had used a pump for some time is only 56. To draw far-reaching conclusions, more patients would have to be interviewed. In addition, the Greater Boston Lymphedema Support Group has a bias towards secondary arm lymphedema. The survey may have an additional bias in that especially patients who were discontent with the results of pumping may have looked for support within our group. While some of the results seem to point clearly in one direction, it would be interesting to pursue these questions on a larger scale and for different populations. Nevertheless, the large number of negative results should warn any lymphedema patient of the potential for negative effects when using a pneumatic pump.
Robert Lerner, MD, FACS: Problems with Pneumatic Pumps, Lymphedema Services P.C. Newsletter, Vol. 3, No.1, August 1995.
Christos J. Pappas, MD and Thomas F. O'Donnell, Jr., MD, FACS: Long-term results of compression treatment for lymphedema. Journal of Vascular Surgery Vol.16, no. 4, October 1992, p.555-564.