Imipramine in Patients with Chest Pain Despite Normal Coronary Angiograms

Cannon, Richard O.; Quyyumi, Arshed A.; Mincemoyer, Rita; Stine, Annette M.; Gracely, Richard H.; Smith, William B.; Geraci, Marilla; Black, Bruce C.; Uhde, Thomas W.; Waclawiw, Myron A.; Maher, Kathleen A.; Benjamin, Stanley B.

doi:10.1056/nejm199405193302003

Cited by 458 publications

(198 citation statements)

References 49 publications

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“…20 However, our study showed that, although a significant decrease in pain intensity was recorded, there was no change in the motility pattern at the end of the study. This is in contrast with earlier studies, in which the motility pattern changed with time, 31 but in agreement with earlier studies of trazodone 24 and imipramine, 32 where pain relief was accomplished without any effect on motility. These results suggest that the role of the contractile abnormality in the pathophysiology of non-cardiac chest pain in nutcracker oesophagus is small, if any.…”

supporting

confidence: 88%

Nutcracker oesophagus: a double‐blind, placebo‐controlled, cross‐over study of the effects of lansoprazole

Börjesson¹,

Rolny

Mannheimer³

et al. 2003

Aliment Pharmacol Ther

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SUMMARYBackground: Nutcracker oesophagus is characterized by high-amplitude oesophageal contractions. Recent data have shown a high prevalence of gastro-oesophageal acid reflux in patients with nutcracker oesophagus and, in open-label trials, patients seemed to benefit from acid suppression. Therefore, it has been suggested that noncardiac chest pain in patients with nutcracker oesophagus may be related to reflux rather than to the motor abnormality itself. Aims: To investigate the effect of intensive acid-suppressive treatment on chest pain in patients with nutcracker oesophagus. Methods: Nineteen patients with nutcracker oesophagus received lansoprazole or placebo in a double-blind, randomized, cross-over study.

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supporting

confidence: 88%

Nutcracker oesophagus: a double‐blind, placebo‐controlled, cross‐over study of the effects of lansoprazole

Börjesson¹,

Rolny

Mannheimer³

et al. 2003

Aliment Pharmacol Ther

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“…931 Imipramine 50 mg daily has been successful in some chronic pain syndromes, including syndrome X, reducing the frequency of chest pain by 50%. 932 Transcutaneous electrical nerve stimulation and spinal cord stimulation can offer good pain control. 933,934 Estrogen in postmenopausal women with angina and normal coronary arteriograms has been shown to reverse the acetylcholine-induced coronary arterial vasoconstriction, presumably by improving endothelium-dependent coronary vasomotion, 935 and to reduce the frequency of chest pain episodes by 50%.…”

Section: Treatmentmentioning

confidence: 99%

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Anderson¹,

Adams²,

Antman³

et al. 2011

Circulation

682

367

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“…Digno de nota também é o fato de que 7 (39%) desses 18 pacientes estavam sendo tratados com ADTs em doses máximas não maiores que 75 mg/dia. Embora eficaz para o tratamento da dor torácica 8,9 , essa dose não é suficiente para o tratamento may partially ameliorate depressive symptoms, making the appropriate diagnosis and treatment of major depression even more difficult, consequently contributing to the persistence of pain and other complains. Considering the wide alternatives to effectively treat depression, a focus on detection and treatment of major depression in patients with chest pain is warranted by clinicians and researchers.…”

Section: Discussionunclassified

Depressão maior em pacientes com dor torácica não cardíaca: Quem vai tratar?

Fráguas

Nobre²,

Wajngarten³

et al. 2009

Rev. psiquiatr. clín.

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Objetivo: Investigar a presença de transtornos psiquiátricos em pacientes com dor torácica de origem não cardíaca que não respondem aos tratamentos regulares. Método: Dezoito pacientes com dor torácica sem origem cardíaca e considerados por seus clínicos como não respondentes aos tratamentos regulares instituídos foram avaliados por um psiquiatra treinado. As entrevistas foram realizadas com base no Present State Examination e os diagnósticos psiquiá-tricos, de acordo com os critérios do Manual de Diagnóstico e Estatística da Associação Psiquiátrica Americana, 3ª Edição Revisada (DSM-III-R). Resultados: Depressão maior no momento da avaliação foi diagnosticada em 6 (30%) pacientes, somatização em 1 (6%) e transtorno do pânico em 1 (6%) paciente. Sete pacientes estavam recebendo antidepressivos tricíclicos com doses < 75 mg/dia. Conclusões: A baixa dose de ADTs usadas para o tratamento da dor nesses pacientes pode ter melhorado parcialmente os sintomas depressivos, tornando mais difíceis o diagnóstico e o tratamento apropriado(s) da depressão e, assim, contribuindo para a persistência da dor e outras queixas. As futuras pesquisas deverão focalizar a eficácia do tratamento da depressão nesses pacientes e o impacto deste no alívio da dor torácica não cardíaca. Fráguas R, et al. / Rev Psiq Clín. 2009;36(3):83-7Palavras-chave: Depressão, cardiologia, dor, tratamento, atenção primária. AbstractObjective: To investigate the presence of psychiatric disorders in patients with chest pain not responsive to treatment. Method: We evaluated 18 patients judged by their physicians to have a chest pain not responsive to usual treatment, which included anti-pain medicines and investigation and treatment of possible etiological causes such as coronary artery disease, and gastroesophageal reflux disease. A psychiatrist interviewed the patients using the Present State Examination and made the diagnosis based on the DSM-III-R criteria. Current major depression was diagnosed in 6 (30%) patients, somatization in 1 (6%) and panic disorder in 1 (6%) patient. Seven patients were receiving tricyclics antidepressant with doses ≥ 75 mg/day. Discussion: Patients were receiving doses of tricyclics antidepressants efficacious for pain but not for major depression. It is possible that the low dose of antidepressants used to treat pain Chest Pain Outpatient Care Unit at

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Imipramine in Patients with Chest Pain Despite Normal Coronary Angiograms

Abstract: Imipramine improved the symptoms of patients with chest pain and normal coronary angiograms, possibly through a visceral analgesic effect.

Cited by 458 publications

References 49 publications

Nutcracker oesophagus: a double‐blind, placebo‐controlled, cross‐over study of the effects of lansoprazole

Nutcracker oesophagus: a double‐blind, placebo‐controlled, cross‐over study of the effects of lansoprazole

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Depressão maior em pacientes com dor torácica não cardíaca: Quem vai tratar?

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