Cannabis and CBD for Pain Info
Last reviewed
What the evidence does and doesn't show for cannabis and CBD in musculoskeletal pain, and practical and safety considerations.
What it is
Cannabidiol (CBD) is a non-psychoactive compound found in cannabis. It is often used as part of a multimodal pain management plan after surgery. For example, studies on arthroscopic rotator cuff repair show that using CBD does not cause deficits in patient-reported outcomes or functional recovery at one-year follow-up compared to a placebo. Buccally absorbed CBD also shows promise for reducing pain in the immediate period after this type of surgery.
You may consider medical cannabis for chronic musculoskeletal or neuropathic pain. Peripheral neuropathy is nerve damage that causes pain, numbness, or tingling. Cannabis-based medicines are applicable for treating this condition. Patients with spine pain estimate that medical cannabis could treat more than half of their pain. One in three patients with spine pain were already using medical cannabis. Additionally, 79% of these patients believe cannabis could reduce opioid usage.
Interest in medical cannabis is also high among patients with hand and upper-extremity complaints. Most patients in this group would consider using medical cannabis (80.9%). They perceive it as a safe treatment option for common orthopedic conditions. Large numbers of patients with osteoarthritis of the thumb basal joint would be interested in trialing oral or topical formulations. However, cost is identified as a major barrier to use for many patients.
While most survey respondents in the orthopaedic sports medicine community believe CBD has a role in postoperative and chronic pain management, definitive conclusions for hand and upper extremity conditions require continued investigation. Regular cannabis use may be associated with increased opioid usage in total joint arthroplasty. Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures. Your doctor can help you weigh these factors.
Does it work?
The answer depends on your specific condition and the type of surgery you are having. For some procedures, cannabis products show promise. For others, they offer no clear benefit or may even cause problems.
If you are having arthroscopic rotator cuff repair, recent evidence suggests that cannabidiol (CBD) is safe to use. It does not cause any deficits in your patient-reported outcomes or functional recovery at 1-year follow-up compared to a placebo. In fact, buccally absorbed CBD shows significant promise in reducing pain in the immediate peri-operative period following this surgery. Your doctor may consider adding it to your postoperative multimodal pain management regimen without long-term detrimental effects.
However, the evidence is mixed for other conditions. For patients with traumatic brachial plexus injuries, cannabis-based medicine did not provide clinical improvement in pain or sleep quality compared with a placebo. There is no clinically important benefit to using it as an add-on to standard drug therapy for this type of nerve injury.
Your expectations should also be realistic regarding joint replacements. Regular cannabis use may be associated with increased opioid usage in the context of total joint arthroplasty. Cannabis use following total joint arthroplasty is associated with increased risks. While a synthetic form of cannabinoid (THC) does not appear to limit opioid intake after primary total knee arthroplasty, higher-level studies are needed to fully understand the impact. No specific guidance can currently be suggested based on these associations.
Many patients believe in its potential. Patients estimated medical cannabis could treat more than half of their spine pain. One in three patients with spine pain already uses medical cannabis. Seventy-nine percent of patients with spine pain believe cannabis could reduce opioid usage. In hand and upper-extremity care, most patients would consider using medical cannabis, and large numbers of patients with osteoarthritis of the thumb basal joint would be interested in trialing it.
Despite this interest, cost is identified as a major barrier to medical cannabis use among patients presenting for hand and upper-extremity complaints. You should discuss these mixed results openly with your doctor to determine if it is a safe and appropriate part of your recovery plan.
Is it right for you?
Many patients find cannabis helpful for specific types of pain. It may be a good option if you have nerve pain in your limbs or wear-and-tear arthritis in your thumb joint. Most people with spine pain believe it could help, and many are already using it. In fact, 79% of patients with spine pain think it could lower their need for opioid painkillers. If you have hand or upper-arm issues, 80.9% of patients like you would consider trying medical cannabis. Most see it as a safe choice for these common problems.
For joint replacements, the picture is mixed. Using cannabis after hip or knee replacement does not seem to change your final results. However, regular use might lead to taking more opioids after these surgeries. This is why your doctor cannot give simple advice on using it around the time of major joint surgery. More research is needed to make clear recommendations for these procedures.
Cost is a major barrier for many patients considering this treatment. Availability varies by location and law. Because the evidence is still growing, especially for joint replacements, this should be a shared decision with your doctor. They can help you weigh the potential benefits against the risks and costs. For minor surgeries like rotator cuff repair, cannabidiol (CBD) appears safe and does not harm your recovery at one year. Always talk to your care team before starting any new treatment.
The bottom line
You can consider cannabidiol (CBD) as part of your pain plan after rotator cuff repair. It shows no long-term harm and may help with immediate pain. For spine or hand pain, many patients use it to manage symptoms or reduce opioids. However, regular cannabis use may increase opioid needs after joint replacement. Your doctor will guide you on safety, cost, and whether it fits your specific procedure.
