Surgeons Interested in Using Cannabidiol (CBD) as a Potential Pain Management Strategy After Surgery
Orthopedic surgeons expressed positive attitudes overall toward the potential use of cannabidiol (CBD) for pain relief after surgery, provided that more research is conducted on the subject, according to a survey done at Hospital for Special Surgery (HSS) and presented at the 2019 Society of Anesthesia and Sleep Medicine (SASM) Annual Meeting.1
If found to be beneficial with minimal side effects, CBD could be especially useful in patients with comorbidities that put them at increased risk of harm from opioids, such as obstructive sleep apnea (OSA).
In recent years, clinicians and researchers have increasingly focused on relieving pain after surgery using multiple nonopioid pain management approaches, referred to as multimodal analgesia. The technique can lessen the amount of opioids patients take for pain relief, or even eliminate the need for opioids altogether.
“Sleep apnea is directly impacted by medications that are respiratory depressants. Any of the drugs we use during an anesthetic, including opioids, will decrease respiratory function and make it easier for patients to collapse their airway, which is really the one feature that makes up sleep apnea,” explained Stavros Memtsoudis, MD, PhD, MBA, a lead researcher on the study who is an anesthesiologist at HSS and president of the SASM. “Because of that, there is always concern about using opioids in patients with sleep apnea, that you’re going to make their symptoms worse, which can potentially lead to significant complications.”
“There’s an increasing awareness of this problem. Therefore, anesthesiologists try to avoid opioids by utilizing alternative approaches such as peripheral nerve blocks. In addition to that, we use nonopioid analgesics to achieve pain control without impacting respiration,” he said. “CBD, by virtue of its anti-inflammatory action, could potentially have some pain-relieving properties, without having the depressant effects of opioids.”
To examine surgeons’ current knowledge about CBD’s clinical uses and their interest in CBD as a potential recovery method after surgery, researchers designed an anonymous 11-item questionnaire and distributed it to surgeons at HSS.
A total of 94 clinicians, mostly joint arthroplasty orthopedists or sports medicine specialists with less than 5 years to more than 25 years in practice, completed the questionnaire. The survey results showed:
- 86% of surgeons were familiar with CBD, though only 4% said they were very familiar
- No surgeons thought CBD harmed the recovery process; 28% thought of it as a useful adjunct to recovery; 68% said they did not know if it was useful
- Of those who said they thought CBD was a useful adjunct, 64% thought it was either moderately or very useful
- 77% of surgeons said they would agree to the use of CBD during recovery if suggested by a patient or another provider
- 83% of surgeons expressed interest in learning more about CBD; 88% expressed interest in further study of CBD;
- 85% were open to recommending it if it is shown to be opioid and/or NSAID sparing;81% would direct a patient to use CBD as part of a multimodal analgesia recovery plan if shown to be beneficial with minimal side effects
- 24% of surgeons listed concerns with CBD including safety and/or a lack of clinical data
“We found that the surveyed surgeons expressed generally positive attitudes toward the use of CBD and expressed a desire for further study to address safety and efficacy of CBD in their patients,” said HSS researcher Alexandra Sideris, PhD. “CBD has never been studied before for recovery from surgery, mainly due to regulatory barriers precluding surgeons and clinicians from studying this compound within a hospital. Recent legislative changes are giving researchers and clinicians the opportunity to study CBD, and we are now taking advantage of that opportunity.”
1. Alexandra Sideris PhD, Valeria Rotundo BA, Kethy M Jules-Elysee MD, Jawad Saleh PharmD, Stavros G. Memtsoudis MD PhD MBA. “Cannabidiol as part of multimodal pain management? A survey of surgeons’ attitudes and knowledge.” Presented at 9th Annual Society of Anesthesia and Sleep Medicine Meeting (SASM), October 17-18, 2019; Orlando, FL.
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.