I was fitted for a custom made compression sleeve, and I love it. I have tiny wrists, too, and a long arm, so that even the smallest stock size didn't work for me. Insurance covered that cost, just as they would an off-the-shelf model!
My arm continues to be painful, but when I wear the sleeve, the pain is controlled. Also, my PT and OT said I should always wear the sleeve when exercising, and especially when traveling, due to the imoblility involved in sitting for long periods. Flying with the sleeve on is also a necessity, due to the pressurized cabin on the plane. They also told me to stop when traveling every couple of hours to walk about a bit, even on an airplane. The whole lymphadema thing is nothing to mess with!
Good luck to you and take care,
Jean in WA