Painful obesity disease mainly manifests as painful nodules or fat masses on top of obesity. Painful obesity is a rare autonomic nervous system disorder of unknown etiology, manifesting as an abnormal accumulation of subcutaneous fat in certain areas of the trunk and accompanied by spontaneous pain in that area. The disease was first described by Dercum (1892) and is therefore also known as Dercum’s disease. What are the symptoms that can be easily confused with it? 1, nodular febrile non-suppurative lipofuscinosis Chronic course, recurrent, with scattered subcutaneous nodules throughout the body, but no spontaneous pain, normal or red, brown or purplish skin color, the vast majority of patients have fever, and often accompanied by lesions at the same time. The pathological manifestations are mainly the inflammatory reaction of subcutaneous fat and fatty degeneration and necrosis. 2.Multiple neurofibromas Many milk coffee-like spots are often seen on the skin of patients, and histopathological biopsy can confirm the diagnosis of neurofibromas. Multiple angiomyolipomas can be clearly diagnosed by histopathological biopsy of lipoma. The majority of female patients with this disease are 30-50 years old, i.e. women of childbearing age, often accompanied by premature menopause and early hypogonadism. The main manifestation is the appearance of painful nodules or fat masses on the basis of obesity, varying in size, with fat deposits in the trunk, neck, axilla and waist and buttocks, with asymmetric distribution. The fat nodules are soft in the early stage and hard in the late stage. As the fatty nodules increase in size, the pain increases, along with numbness, weakness and sweating disorders. The nature of the pain is sharp pinprick-like or knife-like pain, paroxysmal or continuous, with pressure pain along the nerve trunk. It is often accompanied by arthralgia, and generalized weakness is the prominent symptom, but there is no evidence of organic pathology.