Gastrointestinal (GI) disorders that cause pain are a relatively common malady in children. These disorders, including irritable bowel syndrome and dyspepsia, among others, are responsible for countless visits to doctors’ offices. While GI disorders and appropriate treatments are well understood in adults, there is a noticeable lack of reliable data regarding these conditions in children. Previous studies have suggested that low doses of tricyclic antidepressants are beneficial for adults with irritable bowel syndrome (IBS). Specifically, the antidepressant medication Elavil (amitriptyline) is believed to ease the pain and anxiety associated with IBS. A recent study of children with GI disorders attempted to answer the question of whether a similar treatment plan might be successful with much younger patients.
Pediatric gastroenterology clinics at six locations throughout the United States were selected as sites from which to recruit subjects for the study. Eighty-three children between the ages of 8 and 17 years completed the study. Before and after the study, children were carefully assessed to determine the type and severity of their condition, overall psychological state, and typical daily activity levels. The study consisted of a 4-week treatment with either Elavil or placebo. Children kept a daily record of their experience of pain and other symptoms.
The results of the study were perhaps not as informative as the researchers had hoped. Statistical analysis revealed that Elavil did no better than placebo in terms of easing pain. About half the children in both groups reported that their medication was either “excellent” or “very good” at relieving their pain. This proportion was the same regardless of sex, age, type of GI disorder, or any other study variable. Children who began the study with more severe pain reported less improvement than those with only mild or moderate pain. The only significant effect that differentiated Elavil from placebo was a reduction in anxiety, a common symptom of many GI disorders. Seven children dropped out of the study because of adverse effects, although in most cases side effects were negligible.
The power of the “placebo effect” in this particular study highlights the fact that any treatment is better than no treatment. Furthermore, children in pain experience a diminished quality of life and underperform in school. They may also develop mood disorders such as depression or anxiety. Elavil’s combination of safety and effectiveness in treating mild or moderate GI disorders in children argues for its use. At the same time, counseling and other social interventions can counteract any psychological issues that children with GI disorders may experience.
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Amitriptyline. Retrieved March 19, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000666/
- Saps, M., Youssef, N., Miranda, A., Nurko, S., Hyman, P., Cocjin, J., et al. (2009). Multicenter, randomized placebo-controlled trial of amitriptyline in children with functional gastrointestinal disorders. Gastroenterology, 137(4), 1261-1269.
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