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. 1998 Jun;42(6):807–813. doi: 10.1136/gut.42.6.807

Imipramine decreases oesophageal pain perception in human male volunteers

P Peghini 1, P Katz 1, D Castell 1
PMCID: PMC1727141  PMID: 9691919

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. 



Keywords: antidepressants; imipramine; visceral hyperalgesia; oesophageal balloon; distension; functional bowel syndromes

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Figure 1 .

Figure 1

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Balloon compliance. Mean pressure volume curve of the 30 pre-IOBD, in vitro assessments of the six balloons used in the study. 


Figure 2 .

Figure 2

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Relation between balloon volume, pressure, and diameter in vitro. 


Figure 3 .

Figure 3

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Reproducibility of perception thresholds of the two testing days. Volumes at perception threshold for first inflation series (x axis) plotted against volumes at perception threshold for second inflation series 10 minutes later (y axis). (A) Sensation thresholds; (B) pain thresholds. 


Figure 4 .

Figure 4

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Perception thresholds on placebo and imipramine. (A) Volumes at thresholds for first sensation (n=15); (B) volumes at pain thresholds (n=14). Median represented by horizontal bar. 


Figure 5 .

Figure 5

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Balloon volume and pressure at pain threshold for placebo (A) and imipramine (B). 


Figure 6 .

Figure 6

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Volumes at pain threshold on placebo and imipramine. 


Figure 7 .

Figure 7

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Oesophageal wall compliance. Difference between in vivo minus in vitro balloon pressure (mean (SEM)) at corresponding inflation volumes. 


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