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Cannabis users experience somewhat more post-surgery pain than those who abstain

Oct 24, 2022 | Media Partners, The GrowthOp

This post is presented by our media partner The Growth Op
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Weed consumers had 14 per cent more post-operative pain during first 24 hours

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Cannabis is oftentimes used for pain management, at least anecdotally, so it may come as some surprise that marijuana consumers undergoing surgery experience more post-operative pain than non-users.

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Consumption beforehand appears linked to more pain afterward, notes a study presented at the Anesthesiology 2022 annual meeting, held Oct. 21-25 in New Orleans.

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And with that pain, these cannabis users “have higher opioid consumption after surgery,” reports Dr. Elyad Ekrami, a clinical research fellow at Cleveland Clinic’s Anesthesiology Institute and the study’s lead author.

  1. Investigators found that dislocation rates following total knee arthroplasty were significantly higher among cannabis users than non-users. /

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Cannabis has long been cited for its analgesic effect, with European investigators reporting in 2018 “the evidence from current research supports the use of medical cannabis in the treatment of chronic pain in adults.”

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“Both CBD and THC work with receptors that release neurotransmitters in your brain,” which can affect pain, mood, sleep and memory, according to WebMD.

Medical News Today adds that while CBD doesn’t cause a high, “it does interact with pain receptors in the brain to exert pain-relieving and anti-inflammatory effects.”

Looking at the numbers, U.S. investigators analyzed the records of 34,521 adult patients — 1,681 of them cannabis users, defined as consuming bud within 30 days of surgery — who had elective surgeries at Cleveland Clinic from January 2010 to December 2020, per the American Society of Anesthesiologists.

One in seven had more pain within 24 hours post-surgery

Compared to those who abstain, patients who partake had 14 per cent more pain during the first 24 hours after surgery and seven per cent had more opioids.

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MedPage Today reports cannabis users had time-weighted average pain scores after surgery that were 0.58 higher on a scale from 0 to 10.

The difference “was not statistically significant, but is likely clinically relevant,” the statement notes.

Although links among cannabis use, pain scores and opioid consumption has been reported in past, Dr. Ekrami maintains these included conflicting results.

“Our study has a much larger sample size and does not include patients with chronic pain diagnosis or those who received regional anesthesia, which would have seriously conflicted our results,” he points out.

Cannabis tolerance may reduce pain medication effectiveness

According to HealthLine, Dr. Samer Narouze, chairman of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls, Ohio, told the website that cannabinoid receptors often overlap with opioid receptors in the spine and brain, and both are involved in pain regulation.

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Dr. Narouze noted that this could open the door for cannabis users to develop a tolerance for opioid medications. He further reported that at low doses, THC can reduce pain, but may amplify pain at high doses.

It’s also possible that some patients involved in the recently released study are using cannabis to self-medicate and cope with anxiety or emotional problems, Dr. Qian Cece Chen, an anesthesiologist with NYU Langone Health in New York City, told U.S. News.“ In pain management, we know anxiety contributes to pain,” Dr. Chen said, adding that since cannabis could not be consumed while in hospital, “it’s possible that their unmanaged anxiety causes them to be more sensitive to pain.”

More research is necessary

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More research is needed to define cannabis’ effects on surgical outcomes, Dr. Ekrami says of the recent study, but adds that “physicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery.”

As part of study findings published in 2018, investigators with the University of Michigan reported that “cannabis users have higher clinical pain, poorer scores on quality-of-life indicators and higher opioid use before and after surgery.”

Another study released in 2020 looked at the anesthesiology needs of 118 patients who underwent surgery for a broken shin bone (patients did not include chronic pain sufferers or those with records indicating previous opioid use).

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Considering signals like involuntary body movements, increased heart rate and possible signs of experiencing more pain, the review found weed consumers required an average of 37.4 millilitres of anesthetic compared to 25 millilitres for non-users. They also reported pain scores averaging six compared to 4.8 and received 58 per cent more opioids daily while in the hospital.

That said, research published in 2022 found no big differences in cost, opioid use or complication rates among those using cannabis after hip arthroscopy.

We’d love to hear from you. Get in touch with feedback and story tips at thegrowthop@postmedia.com

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