Cannabis and CBD for Pain Info Evidence
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
What it is
Cannabis-based medicines contain compounds like cannabidiol (CBD) and tetrahydrocannabinol (THC). These interact with your body’s natural pain signals. You might hear them called medical cannabis.
Many patients with chronic musculoskeletal or nerve pain consider this option. For example, 79% of patients with spine pain believe cannabis could reduce opioid usage. Most patients with hand and upper-extremity complaints would consider using medical cannabis (80.9%). They also perceive it as a safe treatment for common orthopaedic conditions.
In some cases, it helps manage pain after surgery. Studies show CBD can be part of a postoperative pain plan without causing functional deficits at 1-year follow-up after rotator cuff repair. However, regular cannabis use may be associated with increased opioid usage in total joint arthroplasty. It is not effective for all conditions, such as traumatic brachial plexus injuries.
Cost is a major barrier for many patients. Your doctor can discuss if it is suitable for your specific condition.
Does it work?
The evidence for cannabis and CBD in orthopaedic pain is mixed. It depends heavily on the type of surgery and the specific condition you are treating.
For rotator cuff repairs, studies show that CBD does not harm your recovery. At one year, patients using CBD had the same patient-reported outcomes and functional results as those using a placebo. In the immediate period after surgery, some forms of CBD may help reduce pain. However, these benefits do not appear to change your long-term recovery trajectory.
Your doctor will note that regular cannabis use may be linked to increased opioid usage after total joint replacements. There is no specific guidance on using cannabis for perioperative pain management in this context because of this association. Cannabis use following total joint arthroplasty is also associated with increased risks. More high-quality studies are needed to fully understand the safety and efficacy of cannabis use after hip or knee replacements.
For nerve-related pain, such as peripheral neuropathy, cannabinoids may be applicable. However, for traumatic brachial plexus injuries, cannabis-based medicine did not provide clinical improvement in pain or sleep quality compared to a placebo. There is no clinically important benefit to adding cannabis-based treatment to standard drug therapy for these injuries.
Many patients are interested in medical cannabis. Surveys show that most patients with spine pain believe it could reduce opioid usage. A significant number of patients with thumb arthritis or hand complaints would consider trialing medical cannabis, viewing it as a safe option. Cost remains a major barrier for many.
While some forms of synthetic cannabinoids do not limit opioid intake after knee replacement, the overall picture is complex. We cannot promise that cannabis will work for your specific pain. It may help some people with certain types of pain, but it carries risks, particularly after joint replacements. We will discuss whether it is a suitable part of your multimodal pain management plan based on your individual needs and the latest evidence.
What are the risks?
For most people, cannabidiol (CBD) is well tolerated. Studies show no long-term harm to your shoulder function or reported outcomes one year after rotator cuff repair. Buccally absorbed CBD, which dissolves under the tongue, shows an acceptable safety profile for short-term pain relief in the immediate period after surgery. However, cannabis-based medicines did not improve pain or sleep quality compared with a placebo for patients with traumatic brachial plexus injuries.
Regular cannabis use may be associated with increased opioid usage after total joint replacement. A synthetic form of cannabinoid (THC) does not appear to limit opioid intake after primary total knee replacement. Cannabis use following total joint arthroplasty is associated with increased risks. Further studies are needed to determine the safety of perioperative cannabis use after total hip arthroplasty.
Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures. Cost is a major barrier to use for many patients. Most patients perceive medical cannabis as a safe option, but evidence on its efficacy varies by condition.
Is it right for you?
Cannabidiol (CBD) may fit into your pain plan after arthroscopic rotator cuff repair. It does not harm your results at one year. It also avoids long-term negative effects. Many patients with thumb arthritis or hand issues would try medical cannabis for their pain. Most see it as a safe option.
However, regular cannabis use may increase your need for opioids after joint replacement. It does not change outcomes after total hip surgery, but risks remain higher. We cannot give specific guidance for perioperative use because of this link to increased opioid usage.
CBD has a role in managing chronic pain and recovery for many. But it is not a standalone fix. You should discuss this with your doctor. They can weigh your specific condition against the evidence.
For spine pain, many patients believe cannabis could help. About one in three already use it. Most think it could reduce opioid use. Yet cost is a major barrier for many.
Your doctor will help you decide if this fits your goals. They will consider your other treatments and health history. This is a shared decision. Do not start or stop any medication without their advice.
The bottom line
You can consider cannabidiol (CBD) as part of your pain management plan after rotator cuff repair, with no long-term harm shown at one year. It may help with nerve pain, though it did not improve sleep or pain in brachial plexus injuries. Be aware that regular cannabis use may increase opioid needs after joint replacements. Your doctor will discuss if this option suits your specific recovery goals.
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview
- Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without detrimental effects on patient-reported outcomes versus placebo at 1-year follow-up after arthroscopic rotator cuff repair [1].
- Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without long-term functional deficits at 1-year follow-up after arthroscopic rotator cuff repair [2].
- Cannabis-based medicines are applicable for the treatment of peripheral neuropathy [3].
- Regular cannabis use may be associated with increased opioid usage in the context of total joint arthroplasty [4].
- No specific guidance in the use of cannabis in perioperative pain management can be suggested based on the association between regular cannabis use and increased opioid usage in total joint arthroplasty [4].
- Patients estimated medical cannabis could treat more than half of their spine pain [5].
- One in three patients with spine pain already uses medical cannabis [5].
- 79% of patients with spine pain believe cannabis could reduce opioid usage [5].
- Most survey respondents in the orthopaedic sports medicine community believed that CBD has a role in postoperative and chronic pain management [6].
- Large numbers of patients with osteoarthritis of the thumb basal joint would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their thumb basal joint pain [7].
- Most patients presenting for hand and upper-extremity complaints would consider using medical cannabis (80.9%) [8].
- Patients presenting for hand and upper-extremity complaints perceive medical cannabis as a safe treatment option for common orthopedic conditions [8].
- Cost is identified as a major barrier to medical cannabis use in patients presenting for hand and upper-extremity complaints [8].
- A synthetic form of cannabinoid (THC) does not appear to limit opioid intake after primary total knee arthroplasty [9].
- Current evidence demonstrates efficacy and safety for chronic musculoskeletal and neuropathic pain regarding medical cannabis in hand surgery [17].
- Definitive conclusions regarding the efficacy of medical cannabis in hand and upper extremity conditions require continued investigation [17].
How It Works
- Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without detrimental effects on patient-reported outcomes at 1-year follow-up after arthroscopic rotator cuff repair [1].
- Buccally absorbed cannabidiol (CBD) demonstrates an acceptable safety profile and shows significant promise in reducing pain in the immediate peri-operative period following arthroscopic rotator cuff repair compared to control [14].
- Patients estimated that medical cannabis could treat more than half of their spine pain [5].
- One in three patients with spine pain were already using medical cannabis [5].
- 79% of patients with spine pain believe that cannabis could reduce opioid usage [5].
- Most survey respondents in the orthopaedic sports medicine community believed that cannabidiol (CBD) has a role in postoperative and chronic pain management [6].
- Cost is identified as a major barrier to the use of medical cannabis among patients presenting for hand and upper-extremity complaints [8].
- A majority of sports medicine surgeons believe that cannabidiol (CBD) has a role in post-operative and chronic pain management [10].
- Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after total hip arthroplasty to help guide orthopaedic surgeons in counseling patients [11].
- Cannabis-based medicine did not provide clinical improvement in pain compared with a placebo in patients with traumatic brachial plexus injuries [12].
- Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures [15].
What the Evidence Shows
- Cannabidiol (CBD) use after arthroscopic rotator cuff repair demonstrates no deficits in patient-reported outcomes versus placebo at 1-year follow-up [1].
- Cannabidiol (CBD) use after arthroscopic rotator cuff repair demonstrates no functional deficits at 1-year follow-up [2].
- Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome [1].
- Cannabidiol (CBD) can be considered in a post-operative multimodal pain management regimen without long-term detrimental effects [2].
- Buccally absorbed cannabidiol (CBD) demonstrates an acceptable safety profile following arthroscopic rotator cuff repair [14].
- Buccally absorbed cannabidiol (CBD) shows significant promise in reduction of pain in the immediate peri-operative period following arthroscopic rotator cuff repair compared to control [14].
- One in three patients with spine pain already use medical cannabis [5].
- Most survey respondents in the orthopaedic sports medicine community believe that CBD has a role in postoperative and chronic pain management [6].
- Cost is identified as a major barrier to medical cannabis use among patients presenting for hand and upper-extremity complaints [8].
- A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management [10].
- Cannabis use does not affect outcomes after total hip arthroplasty [11].
- Cannabis-based medicine did not provide clinically important benefit as an adjuvant to standard multimodal drug therapy for neuropathic pain in traumatic brachial plexus injuries [16].
- Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing total joint arthroplasty [13].
Practical Considerations
- Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without long-term detrimental effects after arthroscopic rotator cuff repair [2].
- Large numbers of patients with osteoarthritis of the thumb basal joint would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their pain [7].
Key Evidence
- [L2] These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. [1] (10.1177/23259671231222265)
- [L2] These findings suggest that CBD can be considered in a post-operative multimodal pain management regimen without long-term detrimental effects. [2] (10.1177/2325967123s00172)
- [L2] These findings suggest the applicability of cannabis-based medicines for peripheral neuropathy. [3] (10.1016/j.jhsa.2024.09.015)
- [Paper] Regular cannabis use may be associated with increased opioid usage in the context of total joint arthroplasty, and no specific guidance in the use of cannabis in perioperative pain management can be suggested based on this discovery. [4] (10.1097/corr.0000000000003472)
- [L4] Patients estimated medical cannabis could treat more than half of their spine pain, with one in three patients already using medical cannabis, and 79% of patients believe cannabis could reduce opioid usage. [5] (10.1186/s13018-024-04558-6)
- [L4] Most survey respondents believed that CBD has a role in postoperative and chronic pain management. [6] (10.1177/23259671231191766)
- [L4] Large numbers of these patients would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their thumb basal joint pain. [7] (10.1016/j.jhsa.2021.10.018)
- [L3] Most patients presenting for hand and upper-extremity complaints would consider using medical cannabis (80.9%) and perceive it as a safe treatment option for common orthopedic conditions, with cost identified as a major barrier to use. [8] (10.1016/j.jhsg.2022.02.009)
- [L1] Despite enthusiasm for cannabis after orthopaedic surgical procedures, this THC does not appear to limit opioid intake after primary TKA. [9] (10.1016/j.arth.2026.02.047)
- [L4] A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management. [10] (10.1177/2325967123s00336)
- [L3] Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after THA to help guide orthopaedic surgeons in counseling patients. [11] (10.1016/j.arth.2023.03.040)
- [L1] Cannabis-based medicine did not provide clinical improvement in pain compared with a placebo in patients with traumatic brachial plexus injuries. [12] (10.1097/corr.0000000000003221)
- [L1] Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing TJA. [13] (10.1016/j.arth.2023.07.008)
- [L1] Buccally absorbed CBD demonstrates an acceptable safety profile and shows significant promise in reduction of pain in the immediate peri-operative period following ARCR compared to the control. [14] (10.1016/j.jse.2023.02.032)
- [L2] Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures. [15] (10.1016/j.jhsg.2026.100948)
- [Paper] This is a commentary on a randomized controlled trial by Kittithamvongs et al., which found no clinically important benefit to cannabis-based treatment as an adjuvant to standard multimodal drug therapy for neuropathic pain in traumatic brachial plexus injuries. [16] (10.1097/corr.0000000000003265)
- [L4] Current evidence demonstrates efficacy and safety for chronic musculoskeletal and neuropathic pain, but definitive conclusions regarding efficacy in hand and upper extremity conditions require continued investigation. [17] (10.1016/j.jhsa.2022.11.008)
References
[1] Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671231222265
[2] Poster 186: Cannabidiol for Post-Operative Pain Control after Arthroscopic Rotator Cuff Repair Demonstrates No Functional Deficits at 1-Year. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00172
[3] The Use of Cannabinoids in the Treatment of Peripheral Neuropathy and Neuropathic Pain: A Systematic Review. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.015
[4] CORR Insights®: Do Medical and Recreational Marijuana State Laws Impact Trends in Postoperative Opioid Prescriptions Among Patients Who Have Undergone TJA?. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003472
[5] Perceptions in orthopedic surgery on the use of cannabis in treating pain: a survey of patients with spine pain (POSIT Spine). Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04558-6
[6] Perceptions and Opinions on Cannabidiol in the Orthopaedic Sports Medicine Community. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231191766
[7] Assessment of Medical Cannabis in Patients With Osteoarthritis of the Thumb Basal Joint. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.10.018
[8] Hand Surgery Patient Perspectives on Medical Cannabis: A Survey of Over 600 Patients. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.02.009
[9] A Synthetic Form of Cannabinoid Does Not Decrease Opioid Use After Total Knee Arthroplasty: A Prospective, Randomized, Triple-Blind, Placebo-Controlled Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.02.047
[10] Poster 373: Perceptions & Opinions on Cannabidiol Among Sports Medicine Orthopaedic Surgeons. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00336
[11] Cannabis Use Does Not Affect Outcomes After Total Hip Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.03.040
[12] Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003221
[13] Cannabis Use Following Total Joint Arthroplasty is Associated With Increased Risks? A Meta-Analysis. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.07.008
[14] Effects Of Cannabidiol On Post-Operative Pain Following Arthroscopic Rotator Cuff Repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.032
[15] Is Cannabis Dependence Associated with Postoperative Infections in Hand and Wrist Surgeries?. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100948
[16] CORR Insights®: Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003265
[17] Medical Cannabis in Hand Surgery: A Review of the Current Evidence. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.11.008
