Screening for lipedema in women with lower extremity pain and its associations with functional status, pain, mood, and quality of life: A questionnaire-based case–control study

Objectives This study aimed to determine the frequency of probable lipedema among women with lower extremity pain (LEP) using a validated screening questionnaire and to examine its associations with neuropathic pain (NP) characteristics, functional status, psychological symptoms, and health-related quality of life (HRQoL). Methods This prospective questionnaire-based case–control study included 133 women, comprising 68 women with LEP and 65 age-matched healthy controls. Participants were evaluated using the Lipedema Screening Questionnaire (LSQ), Lower Extremity Functional Scale (LEFS), Hospital Anxiety and Depression Scale (HADS), PainDETECT questionnaire, and 12-Item Short Form Health Survey (SF-12). An LSQ score of ≥8 was classified as probable lipedema, whereas a score of ≥12 was classified as high-probability lipedema. These categories indicate screening probability rather than a confirmed clinical diagnosis of lipedema. Group comparisons, correlation analyses, and multivariable regression analyses were performed to examine factors associated with LSQ and LEFS scores. Results Women with LEP had significantly higher LSQ scores and a greater proportion of probable lipedema (36.8% vs 12.3%, p = .001) and high-probability lipedema (19.1% vs 3.1%, p = .003) than controls. Compared with controls, women with LEP had poorer lower extremity function, greater anxiety symptoms, more prominent NP characteristics, and lower physical and mental HRQoL scores (all p < .05). Higher LSQ scores were positively correlated with PainDETECT scores (r = 0.446, p < .001), whereas pain intensity was not significantly correlated with the evaluated clinical outcomes. In multivariable linear regression, PainDETECT score was independently associated with LSQ score (β = 0.382, p = .004). For functional status, both the SF-12 physical (β = 0.352, p = .001) and mental component scores (β = 0.362, p = .002) were independently associated with LEFS scores. Conclusions Probable lipedema was more frequently identified by LSQ among women with LEP than among healthy controls. NP characteristics were independently associated with greater lipedema-related symptom burden, whereas lower extremity function was independently associated with both physical and mental HRQoL. These findings support the use of lipedema and NP screening as complementary components of the clinical assessment of women with LEP. However, LSQ findings should not be interpreted as a clinical diagnosis of lipedema and require confirmation through appropriate clinical assessment.