Antispasmodic / Spasmolytic /Relaxants

Most medical preoccupation has been with the nervous system as an entity in itself, with the goal of better analgesics, sedatives, tranquillizers and antipsychotics. Traditional interest in such areas was also strong and many plants were favored for their powerful psychoactive properties. However, probably the most widespread use of neuroactive plants, or nervines, nowadays is for their effects on innervated structures rather than on nervous tissue alone.

The spasmolytic is a modern descriptor of the effect of an agent on visceral muscle in vitro, often the isolate guinea pig ileum. The technique is widely use as a model to indicate muscarinic or related receptor activity but is a property with little therapeutic application. By contrast, herbal spasmolytics or relaxants are remedies use to reduce the symptoms of tension in the body. Pre-Cartesian insights into the human condition had no separation between body and mind and this particular holistic view is a constant feature of Asian medicine still. Apart from the obvious psychoactives, remedies were not seen to be acting on the nervous system as such; rather there were many remedies that treated various manifestations of turbulence in the boy linked to what now would be escribe as ‘stress-relate’ conditions.

Even though using other terms, early texts described such conditions as classic hypertension (‘Liverqi rising’), nervous headaches, palpitations, breathless attacks and hyperventilation (‘constriction of the chest’), nervous dyspepsia, dysphagia, irritable bowel and urinary frequency.

The remedies selected for these conditions were seen as somatic in emphasis. The markers for application and effectiveness were physical symptoms. Today, modern phytotherapists refer to many of them as antispasmodics or spasmolytics or, more recently, ‘visceral relaxants’. They are offered to the modern stressed patient as a welcome antidote to the culture of tranquillizers and sedatives, treatments working from ‘the neck down’ to reduce the physical effects of tension without befuddling the brain or impugning their sanity. Western remedies such as those listed later have all developed reputations as useful management measures in helping patients handle and even overcome psychosomatic disorders, perhaps combine with appropriate breathing exercises and adrenaline-reducing aerobic activity. Some Chinese remedies such as Uncaria rhynchopylla were targeted at such conditions and hold out the promise of modern applications.

Antispasmodic herbs effect the nervous system to relieve muscle tension and cramping. Each of these herbs has an affinity to specific uses (e.g. menstrual cramping, ureter cramping, leg cramps, tense muscle shoulders, etc) Reduce constriction and cramping in the muscle. May act through nervous system, or directly on the muscle. An antispasmodic herb suppresses spasms, and reduce muscular tension. Smooth muscles like those that line the stomach contract without conscious control, and cause spasms, cramps and abdominal pain. Some herbal antispasmodics ease muscle cramps throughout the body, others are specific to specific organs and muscle types. Many of these herbs also act on the central nervous system as well and can help relax psychological tension.

For example, Black Cohosh is very effective for all manner of cramping; it can go into a respiratory formula for asthma attacks, for back muscle cramping, in a gallbladder formula for gallbladder spasms.

Lobelia is one of our top antispasmodics. Its specific for muscle issues where there's torsion, twisting as in an accident. Think of black cohosh for whiplash.

Plant remedies traditionally used as spasmolytics and relaxants (anxiolytics)

Corydalis spp., Dioscorea spp. (wild yam), Leonurus cardiaca (motherwort), Lobelia inflata (lobelia), Matricaria recutita (chamomile), Melissa officinalis (lemon balm), Passiflora incarnata (passionflower), Piper methysticum (kava), Scutellaria lateriflora (skullcap), Tilia spp.(Linden flowers), Valeriana officinalis (valerian), Viburnum opulus (cramp bark)

Indications for spasmolytics and relaxants

Anxiety, irritability and restlessness, including in children
Sleeplessness due to anxiety and irritability
Nervous dyspepsia
Irritable bowel and intestinal colic
Tension headaches and migraines
Spasmodic dysmenorrhea

Contraindications

Don’t use in gastric and enteric poisoning incidents

Traditional Therapeutic Insights

Early use of spasmolytics also appears to have been dominated by their emergency indications, notably urinary and biliary colic. The use of milder relaxant treatments was mainly as tisanes for children and in the largely unrecorded but vast realm of family care. As expected, systematic classifications of medicine throughout history are generally silent on this area of popular healthcare.

Relaxants were obviously indicated for functional overactivities; indications such as dyspeptic and colicky conditions were probably the most common (and carminatives such as the spices were the most frequent tisanes). Headaches, teething and restlessness in children and menstrual pains were likely to make up most of the remaining indications. These were usually treated within the home by local remedies with recipes handed down through the family.

Some remedies are more sedative than others. These might be added to a relaxant prescription to increase its impact. However, sedation may be depleting: the more a remedy is chosen for its sedative effects, the shorter the treatment should be and the more tonifying remedies should be added. The latter should also be a major element in prescriptions for the increasing proportion of tension conditions linked with fatigue, debility, depression and exhaustion.

These remedies overlap with the aromatics in their effect on the digestive tract but are more appropriate in hot and febrile conditions. However, in many cases predicting efficacy is difficult, and patients may be encouraged to try a number of these or aromatic remedies to see which suits best. In all cases effects are very quick.

Application

Spasmolytics are best taken immediately before meals. Their impact on the digestion is often increased if taken in hot water infusions.

Spasmolytics and relaxants (also aromatics and volatile spasmolytics used for this purpose) may be best taken as hot infusions, though the ordinary teabag may not be sufficiently strong compared with the traditional brew and in acute cases, traditional doses were very high. However, the following herbs probably work better in aqueous ethanolic extracts: Discorea spp., Lobelia inflata, Passiflora incarnata, Piper methysticum, Valeriana officinalis, Viburnum opulus.

Long term therapy is generally well tolerated and may be appropriate, although the use of more sedative remedies should be reduced.

Source: Bone & Mills

Wikipedia:

Smooth muscle spasm

One type of antispasmodics is used for smooth muscle relaxation, especially in tubular organs of the gastrointestinal tract. The effect is to prevent spasms of the stomach, intestine or urinary bladder. Both dicyclomine and hyoscyamine are antispasmodic due to their anticholinergic action. Both of these drugs have general side effects and can worsen gastroesophageal reflux disease.

Mebeverine is a muscolotropic spasmolytic with a strong and selective action on the smooth muscle spasm of the gastrointestinal tract, particularly of the colon. It does not have the acetylecholine side effect commonly seen in an anticholinergic antispasmodic.

Papaverine is an opium alkaloid used to treat visceral spasms, erectile dysfunction and investigated as antipsychotic drug due to its potency to inhibit phosphodiesterasePDE10A.

Peppermint oil has been traditionally used as an antispasmodic, and a review of studies on the topic found that it "could be efficacious for symptom relief in IBS" (as an antispasmodic) although more carefully controlled studies are needed. A later study showed it is an effective antispasmodic when test-applied topically to the intestine during endoscopy.

Bamboo shoots have been used for gastrointestinal and antispasmodic symptoms. Anisotropine, Atropine, Clidinium bromide are also the most commonly used modern antispasmodics.

Skeletal muscle spasm

Pharmacotherapy may be used for acute musculoskeletal conditions when physical therapy is unavailable or has not been fully successful. Another class of antispasmodics for such treatment includes cyclobenzaprine, carisoprodol, diazepam, orphenadrine, and tizanidine. Effectiveness has not been clearly shown for metaxalone, methocarbamol, chlorzoxazone, baclofen, or dantrolene. Applicable conditions include acute back or neck pain, or pain after an injury.

Spasm may also be seen in movement disorders featuring spasticity in neurologic conditions such as cerebral palsy, multiple sclerosis, and spinal cord disease. Medications are commonly used for spastic movement disorders, but research has not shown functional benefit for some drugs. Some studies have shown that medications have been effective in decreasing spasticity, but that this has not been accompanied by functional benefits. Medications such as baclofen, tizanidine, and dantrolene have been used.