P L Peghini1, P O Katz, D O Castell. 1. Department of Medicine, Allegheny University Hospitals, Philadelphia, Pennsylvania 19146, USA.
Abstract
BACKGROUND:Visceral hyperalgesia is a hallmark of functional gastrointestinal disorders. Antidepressants improve symptoms in these patients, although their mode of action is unclear. Antidepressant, anticholinergic, and analgesic mechanisms have been proposed. AIMS: To investigate whether imipramine, which has a visceral analgesic effect, increases pain thresholds to experimental visceral pain. METHODS: Visceral perception for first sensation and pain was measured with intraoesophageal balloon distension in 15 male volunteers. The effect of imipramine was studied in a double blind, placebo controlled, crossover study. Imipramine was given in ascending doses for 12 days (25 mg days 1-3, 50 mg days 4-6, 75 mg days 7-12), with oesophageal perception studied on day 13. RESULTS:Inflation volumes and intraballoon pressures at first sensation were not different between placebo and imipramine. Balloon inflation volume at pain threshold was higher on imipramine (p = 0.015). Median intraballoon pressures were not different at pain threshold for placebo and imipramine. Oesophageal wall compliance was not affected by imipramine. CONCLUSION: Increased pain thresholds on imipramine in this group of normal male volunteers in the absence of changes in oesophageal tone imply the presence of a visceral analgesic effect.
RCT Entities:
BACKGROUND:Visceral hyperalgesia is a hallmark of functional gastrointestinal disorders. Antidepressants improve symptoms in these patients, although their mode of action is unclear. Antidepressant, anticholinergic, and analgesic mechanisms have been proposed. AIMS: To investigate whether imipramine, which has a visceral analgesic effect, increases pain thresholds to experimental visceral pain. METHODS: Visceral perception for first sensation and pain was measured with intraoesophageal balloon distension in 15 male volunteers. The effect of imipramine was studied in a double blind, placebo controlled, crossover study. Imipramine was given in ascending doses for 12 days (25 mg days 1-3, 50 mg days 4-6, 75 mg days 7-12), with oesophageal perception studied on day 13. RESULTS: Inflation volumes and intraballoon pressures at first sensation were not different between placebo and imipramine. Balloon inflation volume at pain threshold was higher on imipramine (p = 0.015). Median intraballoon pressures were not different at pain threshold for placebo and imipramine. Oesophageal wall compliance was not affected by imipramine. CONCLUSION: Increased pain thresholds on imipramine in this group of normal male volunteers in the absence of changes in oesophageal tone imply the presence of a visceral analgesic effect.
Authors: J L Montastruc; M A Tran; M Blanc; J P Charlet; J David; M Mansat; J Cotonat; M Patacq-Sapijanskas; B Guiraud-Chaumeil; A Rascol Journal: Clin Neuropharmacol Date: 1985 Impact factor: 1.592