Objective. The aim of this prospective study is to assess the effect of liposuction on the pain experienced by women with Dercum's disease (adiposis dolorosa). Design. Pain was examined preoperatively and at 3 months, and 1, 2, 3, and 5 years after liposuction. The subjective pain sensation was evaluated with a visual analog scale and number of words chosen, and the objective pain sensation with the mechanical pressure pain threshold. Setting. Dercum's disease is characterized by obesity and pronounced pain in the adipose tissue. The pain is chronic and often disabling and resistant to traditional analgesics and other pain treatment. However, five reports have been published on the encouraging effect of liposuction. Patients. Pain was evaluated in 53 patients with Dercum's disease that had been operated on with liposuction. As controls, 58 nonoperated subjects with Dercum's disease and 41 obese abdominoplasty patients were followed for 5 years. Results. Both subjective and objective pain measurements revealed a statistically significant decrease in the pain experienced by the Dercum patients after surgery as compared with preoperatively. However, the pain relief diminished over time. Furthermore, a significant postoperative difference could be seen between the Dercum operated group and the Dercum controls as regards measured pain. The difference decreased over time but still lingered 5 years postoperatively. Conclusion. The results suggest that liposuction might alleviate pain in patients with Dercum's disease. However, it is difficult to determine whether the effect is due to the actual surgery or to other factors.