Should You Bother With a Pneumatic Compression Device?

If you had been diagnosed with lymphedema in the mid-20th century, chances are you would have been prescribed therapy with a pneumatic compression device (PCD). At the time, these lymphedema pumps resembled glorified blood pressure cuffs. They featured one chamber filled with pressurized air to squeeze your affected limb.

In some instances, unsupervised patients used the devices at pressures that were too high, causing more harm than good. Even when used properly, case studies show that some patients developed problems associated with the prolonged home use of these intermittent pneumatic compression devices, and little significant relief from their lymphedema symptoms. Patient complaints touched on the shortcomings of such devices; they tended to be both painful, and thus unpleasant to use, and simply ineffective, or even counter-productive.

Of course, time marches on, and so does progress in medical technology. Today, these pneumatic compression devices are far more sophisticated — and far more likely to be of benefit to patients.

PCDs for the New Era

These days, PCDs are multi-chambered devices that supply calibrated, gradient-sequential inflation. In this regard, they more closely emulate the manual lymphatic drainage massage that’s an important part of complete decongestive therapy (CDT) for lymphedema. Of course, manual lymphatic drainage involves applying pressure firmly at the most distant point, and working lymph gradually upwards, toward the trunk, where it’s more likely to drain away naturally. 

In fact, as CDT rapidly rose in popularity in the 1990s, old-fashioned PCDs fell out of favor somewhat. Results were not always favorable, due to certain limitations and potential negative side effects of using one of those early devices. But that’s not to say that these devices are obsolete or should be abandoned altogether.

On the contrary, modern PCDs (also called intermittent pneumatic compression (IPC) devices), are sophisticated tools capable of filling in a piece of the CDT puzzle for certain patients who may be able to benefit from their use. These are typically patients who are unable to perform self-manual lymphatic drainage at home, alone, due to limited mobility or lack of caregiver assistance. Likewise, professionally administered CDT may become impractical, as insurance coverage to pay for this ongoing expense is often limited.

Extra Help At Home for Those Who Need It Most  

In general, a personalized PCD can be used in the home, typically at night, to complement the decongestive work of bandages, compression wear, and manual lymphatic drainage (MLD). Using one of these specialized devices does not mean a patient will be able to forego wearing compression garments as directed, or that he or she may stop receiving MLD therapy if the patient’s physician orders ongoing treatments. 

Woman wearing compression garments.
PCD’s should not be seen as a replacement for wearing proscribed compression garments.

Rather, when used at home, in the evening, the device may contribute significantly to overall efforts to help the patient achieve a better range of motion, limb volume reductions, and reduced perceptions of heaviness and achiness in the affected limb or body area. 

And speaking of body areas, these devices are far better, now, than their predecessors at providing coverage for entire areas of the body that may be involved in a given patient’s lymphedema challenge. For example, a PCD for the upper arm in a patient who developed lymphedema following breast cancer surgery typically provides compression not only at the hand, wrist, forearm and upper arm, but at the upper chest, upper back, and neck area, too.

That’s because lymphedema may affect more than just the upper arm in such an instance. Similarly, a PCD for a lower limb might also provide coverage for the buttock and groin, the better to facilitate drainage from the leg. This additional coverage is provided by certain models of PCDs, through the use of an auxiliary garment to cover the additional areas.

Flexitouch® is one example of this sort of improved, modern device. It is described as “an advanced intermittent pneumatic compression device” for the self-management of lymphedema symptoms. Lympha Press® Optimal™ (LPO) system is another such device. These devices offer customized, programmable treatment options, facilitated by multiple garment sizes and configurations.

Some small, randomized studies have compared the effectiveness of old pneumatic compression cuffs, versus the more sophisticated Flexitouch® system, and concluded that the newer devices are, in fact, more effective, as measured by objective decreases in arm edema achieved using both devices.

Some researchers have noted that the best outcomes are likely to be achieved if a prospective patient undergoes a preliminary trial of one of these devices in a clinical setting. This allows the healthcare professional to assess which device works best before sending the patient home to use the assigned device alone. 

References

Cannon S. Pneumatic compression devices for in-home management of lymphedema: two case reports. Cases J. 2009 Mar 23;2:6625. doi: 10.1186/1757-1626-0002-0000006625.

Fife CE, Davey S, Maus EA, Guilliod R, Mayrovitz HN. A randomized controlled trial comparing two types of pneumatic compression for breast cancer-related lymphedema treatment in the home. Support Care Cancer.

2012 Dec;20(12):3279-86. doi: 10.1007/s00520-012-1455-2. Epub 2012 May 2. 
Maul SM, Devine JA, Wincer CR. Development of a framework for pneumatic device selection for lymphedema treatment. Med Devices (Auckl). 2009;2:57-65. Epub 2009 Dec 4.

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