Cannabis users experience more pain following surgery than nonusers

Patients who use cannabis experience more pain after surgery than patients who do not, a recent study found.

Cannabis has gained popularity amongst young adults in the U.S. Previous data from the 2020 National Survey on Drug Use and Health showed that it was used by 17.9% of people aged 12 years and older (n = 49.6 million) within the last year.

“Cannabis use is growing each year with increased social acceptance and legalization in different states and countries. This brings more attention to effects of cannabis on patients’ surgical outcomes,” Elyad Ekrami, MD, a clinical research fellow at the Cleveland Clinic, told Healio.

Ekrami and colleagues examined 34,521 patients who had elective surgeries lasting for more than 1 hour between January 2010 to December 2020. Of those, 1,681 were cannabis users who used cannabis within 30 days of their surgery, while all other participants had never used cannabis.

The researchers presented their findings at the American Society of Anesthesiologists annual meeting.

The median time-weighted average (TWA) of pain scores in the first 24 postoperative hours was 5.5 in cannabis users and 4.1 in nonusers. Ekrami and colleagues found that cannabis was significantly associated with TWA pain scores, with a between-group difference of 0.58 (95% CI, 0.48-0.68).

While cannabis users had slightly higher median opioid consumption (45 IV morphine mg equivalents [MME]) compared with nonusers (36 MME) in the first 24 postoperative hours, the researchers reported that the finding was not statistically significant.

Ekrami said in a press release that while previous research has examined links between cannabis, pain scores and opioid consumption, his and his colleagues’ study was conducted on a much larger scale that excluded factors — such as patients with chronic pain diagnosis or regional analgesia — that would have interfered with results.

“Furthermore, our study groups were balanced by confounding factors including age, sex, tobacco and other illicit drug use, as well as depression and psychological disorders,” he said in the release.

As for physician implications, Ekrami noted that pain control “might be slightly more challenging in these patients, but as mentioned, the amount of pain is not enormously high to change the pain management guidelines for these patients.”

“Getting a full patient's history will give a better understanding of their pain management,” he said.

References:

• Cannabis use increases pain after surgery, study shows. https://www.asahq.org/about-asa/newsroom/news-releases/2022/10/cannabis-use-increases-pain-after-surgery-study-shows#:~:text=The%20patients%20who%20used%20cannabis,but%20is%20likely%20clinically%20relevant. Published Oct. 23, 2022. Accessed Oct. 26, 2022.
• Ekrami E, at al. Association between cannabis use and postoperative opioid consumption. Presented at: American Society of Anesthesiologists annual meeting; Oct. 21-25, 2022; New Orleans.
• Highlights for the 2020 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/2021-10/2020_NSDUH_Highlights.pdf. Accessed Oct. 26, 2022.