Cannabis use before surgery increases pain afterwards

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Some experts recommend people stop using cannabis at least several days before surgery. Ascension X Media/Getty Images
  • Researchers say people who use cannabis tend to experience more pain after surgery than people who don’t.
  • They add that cannabis users tend to use more opioids after surgery.
  • Experts say cannabinoid receptors in the brain may overlap with opioid receptors.
  • They add that cannabis users can develop a tolerance to opioids, which makes these painkillers less effective.

Cannabis is often touted for pain relief and some research supports this claim.

However, a new study reveals that cannabis users may experience more pain, not less, after undergoing surgery.

The study was presented at the 2022 Annual Meeting of Anesthesiology of the American Society of Anesthesiologists in New Orleans. The results have not yet been published in a peer-reviewed journal.

In their study, the researchers looked at more than 34,000 people who had elective surgery at the Cleveland Clinic, including more than 1,600 cannabis users.

They reported that those who used cannabis within 30 days of surgery experienced 14% more pain within 24 hours of surgery. They said cannabis users also took 7% more opioid painkillers than non-users.

The results match previous research showing that up to 20% of cannabis users experience higher levels of post-surgical pain, said Dr. Samer Narouze, president of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls, Ohio. , and a member of the American Society of Anesthesiologists’ Committee on Pain Medicine, told Healthline.

The new study is more comprehensive than previous research that also found associations between cannabis use, pain scores, and opioid use, said Dr. Elyad Ekrami, lead study author and clinical researcher at the Cleveland Clinic Institute of Anesthesiology Outcomes Research Department. , in a press release.

“Physicians should consider that patients using cannabis may experience more pain and require slightly higher doses of opioids after surgery, underscoring the need to continue exploring a multimodal approach to post-surgical pain control,” Ekrami said.

Narouze said cannabinoid receptors often overlap with opioid receptors in the spine and brain. Both are involved in pain regulation.

He said this opens the door for cannabis users to develop a tolerance to opioid medications, thereby limiting their effectiveness.

This also produces the possibility that cannabinoids – a less effective pain reliever – may crowd out opioids at receptor sites.

Another factor could be what Narouze called the paradox of THC, the main psychoactive component of cannabis. In low doses, THC can reduce pain, but in high doses, it can amplify pain.

“Heavy cannabis users are those who experience the most pain after surgery, not occasional users,” Narouze said.

Dr. Kelly Johnson-Arbor, a medical toxicologist and co-medical director of the National Capital Poison Center in Washington, DC, said cannabis use before surgery should be carefully evaluated.

“Those who regularly use cannabis to help manage pain may have an increased tolerance for pain management aids,” she told Healthline. “This may or may not translate to more pain after surgery, as cannabis use is just one of many factors that affect the amount of pain you experience.”

“That’s why it’s so important for patients to be honest with their doctor about their cannabis use. Not disclosing your cannabis use habits to your doctors may result in inadequate anesthesia or postoperative pain control,” Johnson-Arbor added.

One of the limitations of the new study is that it did not collect data from cannabis users on how much they consumed, whether they smoked the drug, or whether or not they abstained. to consume before surgery, said Narouze.

Narouze advised cannabis users who smoke marijuana to refrain from doing so for at least two weeks before any elective surgery.

Dr Jacob Hascalovici, chief medical officer of Clearing, a digital health platform serving people with chronic pain, said cannabis users should avoid using the drug for at least 72 hours before surgery.

“It gives the body some time to adjust to not using cannabis, so patients aren’t affected by the possible impacts of stopping cannabis right after waking up from surgery,” he said. he told Healthline. “It also reduces the chances of cannabis use complicating the operation itself.”

Jordyn Mastrodomenico, clinical director of the ChoicePoint addiction treatment program in Fair Lawn, New Jersey, told Healthline that the cannabis findings are similar to what is known about the effect of smoking and drug use. nicotine on pain relief.

“Patients who smoke have a different pain threshold, and with that in mind, doctors administer higher doses of anesthetics and painkillers,” she said. “It is possible that patients who previously took cannabis may have a low pain tolerance profile since they are already taking a strong drug…Treating pain in a patient who has previously received a strong painkiller is difficult.”

Narouze, whose background includes studying the analgesic effects of cannabinoids, cautioned against using the results as a reason to limit cannabis users’ access to painkillers during post-surgery recovery.

“There have been no reports of significant negative interactions between opiate administration and cannabis use,” he noted.

About Hector Hedgepeth

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