This Study Suggests Avoiding Cannabis Before Surgery to Avoid Increased Postoperative Pain

Cannabis is well-known for its analgesic (i.e., pain-relieving) benefits associated with many different conditions and illnesses. It is often prescribed to patients who suffer from chronic pain. However, some contradictory information from a new study suggests that cannabis may be linked to an increase in pain after surgery. Let’s explore the study’s results and the link between cannabis use and postoperative pain levels. 

The study’s results were presented at the Anesthesiology 2022 annual meeting. The study found that “adults who use cannabis have more pain after surgery than those who don’t use cannabis,” explains the American Society of Anesthesiologists. The study was conducted because there is minimal information on how cannabis may affect patients after surgery. 

Dr. Elyad Ekrami, the lead author of the study and clinical research fellow of the Outcomes Research Department at Cleveland Clinic’s Anesthesiology Institute, explains that “Our study shows that adults who use cannabis are having more — not less — postoperative pain. Consequently, they have higher opioid consumption after surgery.” Indirectly, Dr. Ekrami suggests that cannabis consumption pre-surgery may lead to increased consumption of opioids post-surgery on the basis that those who consume cannabis experience more pain after surgery. 

The study included the analysis of the records of 34,521 adult patients, of which 1681 are cannabis consumers. All study participants had elective surgeries at Cleveland Clinic between January 2010 and December 2020. The cannabis consumers in the study had reportedly consumed cannabis within the past 30 days before their surgery, while the remaining participants had never consumed cannabis. 

American Society of Anesthesiologists Explain Study Results: Cannabis Use May Cause More Postoperative Pain

The American Society of Anesthesiologists explains that “The patients who used cannabis experienced 14% more pain during the first 24 hours after surgery compared to the patients who never used cannabis. Additionally, patients who used cannabis consumed 7% more opioids after surgery, which the authors note was not statistically significant, but is likely clinically relevant.”

Dr. Ekrami explains that “The association between cannabis use, pain scores, and opioid consumption has been reported before in smaller studies, but they’ve had conflicting results” and that “Our study has a much larger sample size and does not include patients with chronic pain diagnosis or those who received regional anesthesia, which would have seriously conflicted our 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.”

Additionally, the doctor states, “Physicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control.”

THC at High Doses May Amplify Postoperative Pain

Dr. Samer Narouze told Healthline that it is the heavy consumers who experience pain after surgery, not the casual users. Dr. Narouze also goes on to explain that the paradox of THC may impact the pain experienced post-surgery as THC at lower doses “can reduce pain, but at high doses, it may amplify pain.” The doctor reminds us that the receptors used by opioids overlap with the receptors used by cannabinoids and that both are involved in pain regulation. 

This is important because cannabis consumers, those who consume enough to build a tolerance, may require more opioids to be effective on account of this tolerance. If regular and heavy cannabis consumers build up a tolerance, which explains the increase in opioids post-surgery, then perhaps a tolerance break would be enough to take care of the potential unwanted increase in opioid administration post-surgery. However, the increase in tolerance may not necessarily explain the increase in pain post-surgery among cannabis consumers. 

You can read this article to learn how to use tolerance breaks to your advantage. 

To get some more context on the grounds of the results of the study, Dr. Kelly Johnson-Arbor explains that “Those who regularly use cannabis to help manage pain may have an increased tolerance when it comes to pain management supports,” and that “This may or may not translate to experiencing more pain after surgery because cannabis use is only one of the many factors that affect how much pain you feel. This is why patients need to be honest with their doctors about their use of cannabis. Not divulging your cannabis use habits to your doctors may lead to inadequate anesthesia or postoperative pain control.”

Avoid Cannabis Use Pre-Surgery

Assuming that the information from the study conducted by Dr. Ekrami and the team is as accurate as they claim, individuals who have upcoming surgeries would do well to avoid cannabis consumption for at least a couple days, but ideally a couple of weeks to one month, before surgery considering the parameters they analyzed during this new study.

Dr. Jacob Hascalovici supports the minimum 72-hour break from cannabis prior to surgery by explaining that it “gives the body a little time to adjust to not having cannabis, so patients aren’t hit with the possible impacts of being off cannabis right after waking up from surgery,” and that “It also reduces the odds that using cannabis may complicate the surgery itself.”

The reason why we say “assuming their information is as accurate as claimed” stems from the fact that their study is currently unavailable beyond the press release from the American Society of Anesthesiologists. When making such a bold, potentially frightening claim, many factors need to be shared. These factors include how much the individuals consume (i.e., what constitutes a heavy user?), how much their pain increased (i.e., what is a 14% increase in pain?), how much more their opioid consumption constitutes (i.e., what is a 7% increase?), etc.

Regardless of the need for more information, these studies are necessary for keeping the cannabis-consuming population well-informed. Until their research gets published or becomes publicly available, consider laying off the cannabis pre-surgery to avoid needing any extra, unnecessary consumption of pharmaceuticals — especially ones as risky as opioids.