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Dercum's disease is primarily characterized by the rapid and continuous development of painful lipomas and/or angiolipomas in affected patients. However, Dercum's disease can also cause chronic and potentially debilitating pain, generalized obesity, weakness, chronic fatigue, and brain fog in affected individuals. These symptoms often far surpass the findings of physical exams and can persist post removal of the most painful lipomas. Here we take steps to begin reconsidering Dercum's disease as a chronic inflammatory disease of the adipose tissue - where lipoma development could be the result of (and not the cause of) aberrant adipose inflammatory signaling. Utilizing a cocktail of medications to address underlying inflammatory signaling and adipose tissue metabolism has led to sustained pain management and lipoma growth suppression in a small cohort of patients, warranting further investigation.