Do cannabis users have more postoperative pain than non-users?

interview with dr Ekrami: Does cannabis use increase pain after surgery?

There are dozens of clinical studies and anecdotal cases documenting the effectiveness of cannabis use for treating different types of pain. It has also been touted as safe for post-operative care, helping patients reduce their recovery time after surgery.

However, many studies advise against using cannabis before surgery. While some find it beneficial for calming nerves, the risk might outweigh the reward. Some studies have found that using cannabis before surgery increases the dose of anesthesia, which can be dangerous for some patients.

Meanwhile, a new study by the study’s lead author, Elyad Ekrami, MD, a clinical research fellow in the Division of Outcomes Research at the Cleveland Clinic’s Institute of Anesthesiology, found that cannabis users tended to experience more pain after surgery, leading to higher opioid intake. They analyzed the medical records of 34,521 adult patients, 1,681 of whom were cannabis users. These patients underwent elective surgeries at the Cleveland Clinic from January 2010 to December 2020.

Those who used marijuana 30 days before surgery experienced 14% more pain within the first 24 hours after surgery than those who never used marijuana. In addition, it was found that cannabis users required 7% more opioids after surgery. According to the authors of the study, 7% are not statistically significant, although they are clinically relevant.

“Cannabis is the most commonly used illicit drug in the United States and is increasingly being used as an alternative treatment for chronic pain, but there is limited data showing how it affects patient outcomes after surgery,” Ekrami explained in one press release. “Our study shows that adults who use cannabis experience more, not less, postoperative pain. Consequently, they have higher opioid use after surgery,” he added.

Opioids are powerful pain relievers prescribed to patients suffering from extreme pain. Some of the most commonly used opioids in hospitals are fentanyl, morphine, tramadol, oxymorphone and oxycodone. Some patients, not all, find relief from opioids, despite their notoriety in recent years for their addictive properties and deadly side effects.

“The association between cannabis use, pain scores, and opioid use has been reported in smaller studies, but they had conflicting results,” says Dr. Ekrami. “Our study has a much larger sample size and does not include patients with a chronic pain diagnosis or patients who received regional anesthesia, which would have seriously conflicted with our results. In addition, our study groups were balanced by confounding factors such as age, gender, tobacco and other illicit drug use, and depression and mental disorders,” he said.

dr Ekrami makes it clear that more research is being done to properly assess the effect of marijuana use on surgical outcomes. “Physicians should keep in mind that patients who use cannabis may experience more pain and require slightly higher doses of opioids post-surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control,” he says.

dr Ekrami was kind enough to answer a few questions from us at Cannabis.net:

Data we received from our study suggests that cannabis use before surgery can lead to higher pain scores and also higher opioid use after surgery. With this data, we cannot make a clear statement that not using cannabis before surgery would reduce her pain. But maybe it can be helpful to take a break before the operation. More data and studies are needed to make a clear statement on this.

Chronic cannabis use can lead to desensitization and down-regulation of CB1, 2, and Mu opioid receptors. These receptors are also targeted by opioid drugs used during surgery. This can be one of the possible reasons. And the other reason we believe is the fact that regular cannabis users do not usually have access to their cannabis during their hospital stay and cannabis is effective in short-term pain management. So they feel more pain in the hospital.

Cannabis has a biphasic effect, meaning that it causes wakefulness and alertness at lower losses, while having a sedating effect at higher doses. However, this does not appear to be related to the design of our study, which is more concerned with postoperative pain. The study you mentioned is probably the study by Hill and colleagues (1974) for which I could not find any recent papers in the literature to support it.

In these patients, regional anesthesia with regional nerve blocks is more likely to be considered. They can also use non-opioid medications like Tylenol or Ibuprofen to control their pain. Opioids need to be used at the right dose for the right time because they have serious side effects at higher doses and the potential for addiction.

I would recommend patients to be honest with their doctors about any drugs or tobacco they use on a regular basis. This will help caregivers better understand and anticipate their pain management.

Conclusion

Cannabis users who may need to undergo surgery in the near future should inform their doctor about their use. Based on the data we have so far, along with the results from Dr. Ekrami, these suggest that it is for your own health to abstain from marijuana until your surgery has healed.

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