A new study says cannabidiol (CBD) can effectively relieve post-operation pain from rotator cuff surgery while being at least as safe as opioids.
The study was presented last weekend at the American Orthopaedic Society of Sports Medicine annual meeting in Colorado Springs.
It detailed research led by Dr. Michael J. Alaia, a sports orthopedic specialist at NYU Langone Health in New York City.
The findings haven’t yet been peer-reviewed or published in a medical journal.
Alaia’s team established a multi-center trial involving 80 subjects from 18 to 75 years of age. One group received a placebo. The other received CBD for 14 days. In the CBD group, the dosage was either 25 mg or 50 mg, depending on the subject’s weight.
The participants’ pain level was recorded on days one two, seven, and 14. Researchers used the visual analog scale (VASTrusted Source) for pain, opioid consumption, and satisfaction with pain control. Liver function was measured on days seven and 14 to assess safety and nausea was monitored.
The researchers reported that on day one the VAS pain score was significantly lower in those receiving CBD. Additionally, although it wasn’t significant, patient satisfaction with pain control trended toward favoring the CBD group. However, researchers also found that there were no statistically significant differences in opioid consumption between the two groups.
The people receiving 50 mg of CBD reported lower VAS scores on day one and higher satisfaction with pain control on days one and two compared to those receiving 25 mg of CBD and the control group.
However, later in the trial, the effects of CBD on the study measures were seen to wane.
On days seven and 14, researchers reported there were no statistically significant differences in VAS score, opioid consumption, or patient satisfaction with pain control. Nor were there significant differences in nausea or liver function.
“Based on our findings, CBD is safe and effective in reducing pain in the immediate peri-operative period following rotator cuff repair and should be considered in postoperative multimodal pain control,” Alaia said in a statement.
Reaction from experts
Dr. Dustin Sulak is a specialist in osteopathic medicine and the founder of Integr8 Health, a medical practice that follows more than 8,000 patients using medical cannabis.
Sulak told Healthline that CBD differs from opioids because it doesn’t target the opioid receptors and, while it may not have as “impressive” an effect on pain, it also lacks the risks.
“CBD’s performance in reducing pain is more similar to anti-inflammatory medicines like ibuprofen, but CBD also lacks many of those side effects like stomach irritation and increased bleeding,” Sulak said.
“Unlike most pain drugs that have one specific target in the body, CBD has multiple mechanisms of action, including modest direct effects on pain reduction, reduction of inflammation that’s contributing to pain, and reduction of anxiety that can intensify pain,” he added.
“CBD is very well tolerated, and at the 25-50 mg doses used in this study, I would expect very few side effects. Those that do have a negative reaction to CBD often describe appetite loss, mild nausea, diarrhea, or restlessness,” Sulak said.
“While it’s helpful to study these two cannabinoids independently, I suspect the research will eventually show that a combination of THC and CBD works best for reducing pain, sparing opioids, and speeding healing,” he added.
Sandra Guynes, MSN, RN, teaches at the Pacific College of Health and Science campus in San Diego. She told Healthline the benefit of using cannabis for post-op pain goes beyond just not being as addictive as opioids.
“Cannabis, specifically cannabidiol, has been noted to be anti-inflammatory, analgesic, and provides relief without the potential for intoxication or euphoria that can be associated with medical cannabis or strains with higher levels of THC,” Guynes said.
“Studies show that cannabidiol is an anti-inflammatory, anti-convulsant, anti-oxidant, anti-emetic, anxiolytic, and antipsychotic agent, and can help mediate our endocannabinoid system (a master communication system in our body) to reduce pain signaling and ease symptoms associated with pain,” she added.
CannabisTrusted Source refers to the products derived from the cannabis plant. Not all cannabis products contain THC.
Guynes cautioned cannabis can still have side effects.
“CBD and cannabis products can potentiate or increase the effects of opioids,” she noted.
“When taken in combination patients should be educated on how to identify and manage these symptoms as well as communicate with their healthcare provider to help adjust any medications as needed. There are also some drug interactions to take into consideration such as warfarin or blood thinners.”
An increasingly older population could benefit from cannabis for pain relief, according to Dr. Daniel Whitelocke, the owner of Ozark MMJ Cards.
“The opiate sparing effect is an important one to consider, as 10 million people misused opioids and 40,000 people died from opiate overdose in 2018,” Whitelocke told Healthline.
“Add this to the idea that total knee and hip replacements are expected to triple in the period from 2010 to 2030. Having another option is truly a public health concern with dire implications.”
Only one CBD product has been approvedTrusted Source by the Food and Drug Administration, although researchers continue to study the potential health benefits for a variety of other health conditions.