Cannabis use appears to be associated with worse pain scores during the first 24 hours after surgery, reports a recent study presented at the recent 2022 Anesthesiology Annual Meeting.
“Cannabis is the most widely used illicit drug in the United States and is increasingly used as an alternative treatment for chronic pain, but there are limited data showing how it affects patient outcomes after surgery,” said Elyad Ekrami, MD, lead author and clinician. Investigator in the Outcomes Research Department of the Cleveland Clinic Institute of Anesthesiology.
“Our study shows that adults who use cannabis have more, not less, postoperative pain,” he added.
Ekrami and her team conducted a retrospective cohort analysis of 34,521 adults who had undergone elective surgeries lasting longer than 1 hour and remained in the hospital for at least 24 hours postoperatively. During the first day after the procedure, cannabis users had a median 45.0 morphine equivalent intravenous (IV) opioid use. [Anaesthesiology 2022, abstract A2061]
By comparison, non-cannabis users consumed only a mean of 36 IV morphine equivalents.
In terms of results, the median time-weighted mean pain scores for the first 24 hours were 5.5 among cannabis users and 4.1 among controls. Linear regression adjusted for inverse probability of treatment weight (IPTW) confirmed that cannabis use was associated with worse pain (mean difference, 0.58, 95 percent confidence interval [CI], 0.48–0.68; p<0.001).
In contrast, and despite baseline differences in use, cannabis use did not show a significant association with opioid use during the first 24 hours after surgery (geometric mean ratio, 1.07, 95 CI %, 0.96–1.19, p=0.19).
“The association between cannabis use, pain scores, and opioid use has been previously reported in smaller studies, but they have had conflicting results,” Ekrami said. “Our study has a much larger sample size and does not include patients diagnosed with chronic pain or those who received regional anesthesia, which would have seriously contradicted our results.”
In addition, the current analysis enrolled a well-balanced study population, with groups balanced for confounding factors such as age, gender, cigarette and other illicit drug use, and psychological disposition.
The cannabis conundrum
In the US, cannabis is the most common illicit drug, with nearly 50 million reported users in 2019, corresponding to about 20 percent of the population, the researchers explained. Usage rates have only been increasing over time.
Despite such prevalence, the pharmacological and pathophysiological links between substance use and pain, particularly after surgery, remain unclear. While there have been several studies investigating cannabis use after surgery, the literature has been largely limited by small sample sizes and variations in patient inclusion criteria.
The present study sought to fill these gaps by including a large sample size and ensuring that patient subgroups were well matched via IPTW. The findings may alert clinicians to the different postoperative care needs of their patients, particularly as it relates to substance use.
“Clinicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control,” Ekrami said.
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