CBD for Pain After Orthopedic Surgery - April 2024

Can CBD Help With Pain After Orthopedic Surgery?

In most cases, doctors will prescribe analgesics such as opioid drugs, painkillers, and nonsteroidal anti-inflammatory drugs (NSAIDs)  to manage the pain following a surgical procedure⁽⁶⁾.

Most patients experience some pain following an orthopedic procedure. The duration and intensity of the pain vary depending on the patient. At the Hospital for Special Services (HSS), many of their patients are referred to the agency’s Perioperative Pain Service (PCPS) for customized pain management⁽⁷⁾.

Also, while some pain medications are effective, they can have side effects detrimental to patients. For instance, taking a nonsteroidal anti-inflammatory drug (NSAID) can cause stomach pain and ulcers⁽⁸⁾.

CBD, the primary nonpsychoactive ingredient of Cannabis sativa L., has gained momentum as a possible therapy for intractable chronic pain in various medical conditions⁽⁹⁾. 

Clinical data indicates that CBD is beneficial for specific types of epilepsy, offers analgesia in certain circumstances, and improves the overall quality of life⁽¹⁰⁾.

The role of endocannabinoids in the management of neuropathic pain has been presented in a review paper. Several studies have shown that the CB1R and the CB2R are involved in this regulation⁽¹¹⁾.

With the increasing effects of phytocannabinoids on various neurological disorders, such as antinociception and chronic pain, the use of these substances has gained growing attention. One of these is Sativex, a drug that combines the active compounds of both THC and CBD⁽¹²⁾.

The cannabis plant’s most abundant phytocannabinoids are 9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive compound in the cannabis plant, while CBD has no psychoactive effects⁽¹³⁾.

A survey conducted by the Hospital for Special Surgery (HSS) and presented at the 2019 Society of Anesthesia and Sleep Medicine (SASM) Annual Meeting found that orthopedic surgeons are receptive to using CBD to reduce post-operative pain⁽¹⁴⁾.

The questionnaire was completed by 94 doctors, predominantly joint arthroplasty orthopedists or sports medicine experts with 5-25 years of experience. 

The poll revealed that only 4% of surgeons stated they were highly acquainted with CBD. However, 77 % of surgeons said they would use CBD during recovery if a patient or another practitioner offered it. At the same time, 88 % of surgeons want to learn more about CBD.

CBD Usage After Orthopedic Surgery: What Research Says

​ Recent research shows that cannabidiol (CBD) tablets may help control pain following shoulder surgery. The CBD did not have the same adverse effects as other regularly used pain drugs⁽¹⁵⁾.

According to Michael Alaia, MD, lead investigator of the study, there is an urgent need for effective pain management alternatives to other pain relievers⁽¹⁶⁾.

The study found that a tablet containing cannabidiol could be a new way to relieve pain without the harmful effects of traditional medicines⁽¹⁷⁾.

Meanwhile, according to research, cannabinoids may provide additional analgesia during orthopedic surgery to combat the overuse of opioids⁽¹⁸⁾. 

However, due to the lack of sufficient evidence, it is not feasible to recommend using these drugs outside of patients participating in studies⁽¹⁹⁾.

The legal barriers to studying the effects of cannabinoids on various medical conditions are expected to continue to dissolve, allowing more research on their potential applications⁽²⁰⁾.

Effectiveness of CBD for Reducing Pain Post-Surgery

Studies on the use of cannabinoids during and post-orthopedic surgery have been conducted. The current evidence is not strong enough to support CBD use after⁽²¹⁾ or even during⁽²²⁾ orthopedic surgery. There is also a need for more rigorous studies to establish CBD effectiveness.

What Is CBD?

A combination of terpene and resorcinol produces the essential compounds in the cannabis plant. One of these compounds is tetrahydrocannabinol, or THC, which is the plant’s main psychoactive component⁽²³⁾.

Other compounds found in the plant include cannabidiol, cannabigerol, cannabinol, and cannabichromene. They are also known to contain beta-caryophyllene, linalool, and piperidine.

Unlike 9-THC, cannabidiol is nonintoxicating. It has numerous beneficial effects, such as its ability to reduce inflammation⁽²⁴⁾ and treat various conditions, such as:

• inflammation and pain⁽²⁵⁾
• inflammatory bowel disease⁽²⁶⁾
• seizures⁽²⁷⁾
• insomnia⁽²⁸⁾
• depression, anxiety, mental disorders⁽²⁹⁾

How to Take CBD

If consumers think of using CBD to manage the pain after orthopedic surgery, consider that CBD products may be used topically, sublingually, orally, or by inhalation.

CBD products are classified into the following categories according to their administration method⁽³⁰⁾:

• Sublingual: CBD sprays or tinctures
• Ingestion: edibles like CBD capsules, gummies, cookies, or chews
• Topical: CBDotions, creams, balms, and salves 
• Inhalation: CBD vapes and smokes 

Sublingual administration⁽³¹⁾ enables rapid absorption of CBD into the system since it avoids the digestive tract and directly into the bloodstream.

For instance, CBD oil must be administered sublingually. This approach allows for dosage adjustment.

Also, CBD oil may be dispensed by inhalation via vapes. However, one study discovered that vapes contain potentially dangerous compounds⁽³²⁾. These chemicals may harm the heart and lungs.

1. Managing Pain after Orthopedic Surgery
   https://www.hss.edu/playbook/managing-pain-after-orthopedic-surgery/
2. Surgeons Interested in Using Cannabidiol (CBD) as a Potential Pain Management Strategy After Surger
   https://news.hss.edu/surgeons-interested-in-using-cannabidiol-cbd-as-a-potential-pain-management-strategy-after-surgery/
3. Tablet Containing Cannabidiol Shows Promise in Reducing Postoperative Pain
   https://nyulangone.org/news/tablet-containing-cannabidiol-shows-promise-reducing-postoperative-pain
4. Tablet Containing Cannabidiol Shows Promise in Reducing Postoperative Pain
   https://nyulangone.org/news/tablet-containing-cannabidiol-shows-promise-reducing-postoperative-pain
5. Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809869/
6. Pain medications after surgery
   https://www.mayoclinic.org/pain-medications/art-20046452
7. Managing Pain after Orthopedic Surgery
   https://www.hss.edu/playbook/managing-pain-after-orthopedic-surgery/
8. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
   https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids
9. A Balanced Approach for Cannabidiol Use in Chronic Pain
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204604/
10. A Balanced Approach for Cannabidiol Use in Chronic Pain
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204604/
11. Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877694/
12. ​​Ibid.
13. Phytocannabinoids
    https://www.sydney.edu.au/lambert/medicinal-cannabis/phytocannabinoids.html
14. Surgeons Interested in Using Cannabidiol (CBD) as a Potential Pain Management Strategy After Surger
    https://news.hss.edu/surgeons-interested-in-using-cannabidiol-cbd-as-a-potential-pain-management-strategy-after-surgery/
15. Tablet Containing Cannabidiol Shows Promise in Reducing Postoperative Pain
    https://nyulangone.org/news/tablet-containing-cannabidiol-shows-promise-reducing-postoperative-pain
16. Ibid.
17. Ibid.
18. Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809869/
19. Ibid.
20. Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809869/
21. Tablet Containing Cannabidiol Shows Promise in Reducing Postoperative Pain
    https://nyulangone.org/news/tablet-containing-cannabidiol-shows-promise-reducing-postoperative-pain
22. Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809869/
23. Cannabidiol (CBD)
    https://www.ncbi.nlm.nih.gov/books/NBK556048/
24. Antioxidative and Anti-Inflammatory Properties of Cannabidiol
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023045/#:~:text=Therefore%2C%20it%20has%20been%20suggested,of%20immune%20cells%20%5B66%5D.
25. Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176325/
26. Cannabidiol in inflammatory bowel diseases: a brief overview
    https://pubmed.ncbi.nlm.nih.gov/22815234/
27. Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514832/
28. Cannabis, Cannabinoids, and Sleep: a Review of the Literature
    https://pubmed.ncbi.nlm.nih.gov/28349316/#:~:text=Recent%20findings%3A%20Preliminary%20research%20into,impair%20sleep%20quality%20long%2Dterm.
29. Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699613/
30. Page 190-193 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
31. SUBLINGUAL MUCOSA AS A ROUTE FOR SYSTEMIC DRUG DELIVERY
    https://innovareacademics.in/journal/ijpps/Vol3Suppl2/1092.pdf
32. 5 Vaping Facts You Need to Know
    https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping