Cannabis and CBD for Pain Info Evidence

What it is

Cannabis-based medicine covers products made from the cannabis plant, including cannabidiol (CBD) and THC. CBD is one part of the plant that does not cause a "high". THC is the part that does. These products come as oils, tablets or creams you can rub on the skin.

People with long-term pain from arthritis, nerve pain, or pain after surgery sometimes ask about it. Many patients are curious. In one survey, 80.9% of people seeing a hand and upper-limb clinic said they would consider using medical cannabis [1]. Among people with spine pain, one in three were already using it [2]. Large numbers of people with wear-and-tear arthritis at the base of the thumb said they would be interested in trying it [3].

How it works is still being studied. Your body has its own system that responds to compounds in cannabis, and this system plays a role in how you feel pain. One review reported that current evidence suggests benefit and safety for long-term muscle, bone and nerve pain [4]. But the picture is mixed. Trials found no clinically important benefit for nerve pain after brachial plexus injuries (a stretch injury to the nerves running from your neck into your arm) [5]. A synthetic form of THC did not appear to limit opioid intake after knee replacement surgery [6].

There are some cautions. Regular cannabis use has been linked with higher opioid use after joint replacement surgery [7]. People with documented cannabis dependence had higher odds of wound problems after hand and wrist soft-tissue surgery [8]. More research is needed before clear advice can be given for many conditions [9, 4].

Does it work?

The honest answer is that it depends on what you are using it for. For long-term muscle, bone and nerve pain, one review reported that current evidence suggests benefit and safety for cannabis-based medicines [4]. A review also found they may help with nerve pain in the limbs away from the spine [11]. But for hand and arm conditions specifically, researchers say we still need more studies before firm conclusions can be drawn [4].

There are some encouraging findings around surgery. CBD can be included in a combined pain-relief plan after keyhole rotator cuff repair without harming your recovery in the short or long term [12, 13]. That means it did not make outcomes worse, not that it was proven to make them better. For teenagers and young adults having hip keyhole surgery, those who used marijuana before surgery had the same pain levels, painkiller needs and recovery as those who did not [14].

Some findings are less positive. Among teenagers having knee ligament reconstruction, those who reported marijuana use needed overnight admission for pain more often and took longer to return to sport [15]. So the same substance can look harmless in one setting and problematic in another.

It is worth knowing who tends to use it. People having keyhole surgery who report cannabis use are usually younger and more often male [16]. And most people seeing a hand and upper-limb clinic see medical cannabis as a safe option for common orthopaedic problems [1].

The bottom line: there is real evidence for some uses, mixed evidence for others, and no good trials yet for many hand and arm conditions. If you are thinking about it, ask your doctor what the evidence says for your specific problem.

What are the risks?

The honest answer is that the risks depend on your situation, and the research does not cover every case. For nerve pain in the limbs, a review found cannabis-based medicines may help [11]. But for nerve pain after brachial plexus injuries (a stretch injury to the nerves running from your neck into your arm), trials found no clinically important benefit when cannabis-based treatment was added to standard pain-relief plans [5].

Around surgery, the picture is mixed. CBD can be included in a combined pain-relief plan after keyhole rotator cuff repair without harming your recovery in the short or long term [12, 13]. One study of CBD absorbed through the cheek found it was well tolerated and reduced pain in the first days after that same operation [17]. But for teenagers having knee ligament reconstruction, those who reported marijuana use needed overnight admission for pain more often and took longer to return to sport [15]. People with documented cannabis dependence had higher odds of wound problems after hand and wrist soft-tissue surgery [8].

For teenagers and young adults having hip keyhole surgery, those who used marijuana before surgery had the same pain levels, painkiller needs and recovery as those who did not [14]. Researchers also looked at whether combining cannabis with nicotine changed the risk of problems after upper limb fracture surgery. They found no clear added effect, but they note the study may not have been large enough to detect a small one [18].

There are real gaps in what is known. One study found cannabis use did not affect outcomes after hip replacement surgery, although its authors say more studies are still needed [10]. Researchers also say more studies are needed for many hand and arm conditions [9, 4]. So if you use cannabis or CBD, tell your doctor. They can weigh what the evidence says for your specific operation or condition, and what it does not yet say.

Is it right for you?

There is no simple yes or no here. Cannabis-based medicine may be worth considering for long-term muscle, bone and nerve pain, where one review reported that current evidence suggests benefit and safety [4]. It may also help with nerve pain in the limbs away from the spine [11]. But for many hand and arm conditions, there are no good trials yet, so nobody can say for certain whether it will help you [9, 4].

Around surgery, the answer depends on your operation and your history. CBD can be part of a combined pain-relief plan after keyhole rotator cuff repair without harming your recovery [12, 13]. But if you have used cannabis regularly, there are some cautions. Regular use has been linked with higher opioid use after joint replacement surgery [7]. And people with documented cannabis dependence had higher odds of wound problems after hand and wrist soft-tissue surgery [8]. Teenagers having knee ligament reconstruction who reported marijuana use needed overnight admission for pain more often and took longer to return to sport [15].

Compared with standard pain-relief plans, cannabis-based medicine is not a replacement. For nerve pain after brachial plexus injuries (a stretch injury to the nerves running from your neck into your arm), trials found no clinically important benefit when it was added to standard care [5]. A synthetic form of THC did not appear to limit opioid intake after knee replacement surgery [6].

The risks section above covers the cautions in more detail. If you are thinking about trying it, talk it through with your doctor first. They can weigh what the evidence says for your specific problem, and what it does not yet say. This should be a shared decision between you and your doctor.

The bottom line

Cannabis-based medicine may be worth considering for long-term muscle, bone and nerve pain, where one review reported that current evidence suggests benefit and safety [4]. Around surgery, CBD can be part of a combined pain-relief plan after keyhole rotator cuff repair without harming your recovery in the short or long term [12, 13]. But the same substance can look harmless in one setting and problematic in another, so the evidence depends on your specific condition or operation. The single most important caveat: tell your doctor if you use cannabis or CBD, so they can weigh what the research says for your situation, and what it does not yet say.

Cannabis and CBD for Pain Info Evidence

What it is

Does it work?

What are the risks?

Is it right for you?

The bottom line

Overview

How It Works

What the Evidence Shows

Postoperative Pain Management

Neuropathic Pain

Patient and Surgeon Perceptions

Practical Considerations

Postoperative Pain Management

Patient and Provider Perceptions

Clinical Guidance and Research Needs

Key Evidence

References