In the Journals

Cannabinoids may reduce pain, opioid consumption after TJA

Thomas Hickernell headshot
Thomas R. Hickernell

Use of cannabinoids in a multimodal pain regimen may help reduce pain and the need for opioid-containing pain medications among patients undergoing total joint arthroplasty, according to published results.

“There is a growing body of anecdotal and circumstantial evidence that cannabinoids, or compounds derived from cannabis plants, may be mitigating the harmful effects of the opioid epidemic in states with medical or recreational cannabis laws on their books,” Thomas R. Hickernell, MD, co-author of the study, told Healio.com/Orthopedics. “We sought to investigate whether dronabinol, an FDA-approved, synthetic [tetrahydrocannabinol] THC in pill form, might decrease patients’ need for opioids for pain control after total hip or total knee replacement.”

Hickernell and colleagues retrospectively compared 81 patients who underwent primary TJA and received 5 mg of dronabinol (Marinol, AbbVie Inc.) twice daily in addition to a standard multimodal pain regimen with a matched cohort of 162 patients who received only the standard regimen. Researchers collected patient demographics, length of stay, opioid morphine equivalents consumed, reports of nausea or vomiting, discharge destination, distance walked in physical therapy and VAS pain scores for both groups.

Results showed the two groups had no significant differences for age, gender, BMI, American Society of Anesthesiologists score, anesthesia type, VAS score, distance walked with physical therapy, discharge disposition or episodes of nausea or vomiting. Researchers found patients who received dronabinol experienced a significantly shorter mean length of stay of approximately 2.3 vs. 3 days in the control group. The dronabinol group also consumed significantly fewer total opioid morphine equivalents, according to results. Despite reports of fewer opioid morphine equivalents consumed per day and per length of stay on average in the dronabinol group, researches noted neither of these achieved statistical significance.

“Cannabinoid medications may, in fact, have a role in a multimodal pain control regimen after total hip or knee replacement and they may decrease the need for opioid pain medications, which is critical in the era of the opioid epidemic,” Hickernell said. “We hope that this study will lead to additional higher quality studies, including prospective randomized controlled trials, to further investigate the potential role of cannabinoids as additional tools in our non-opioid pain control armamentarium.” – by Casey Tingle

 

Disclosures: Hickernell reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

Thomas Hickernell headshot
Thomas R. Hickernell

Use of cannabinoids in a multimodal pain regimen may help reduce pain and the need for opioid-containing pain medications among patients undergoing total joint arthroplasty, according to published results.

“There is a growing body of anecdotal and circumstantial evidence that cannabinoids, or compounds derived from cannabis plants, may be mitigating the harmful effects of the opioid epidemic in states with medical or recreational cannabis laws on their books,” Thomas R. Hickernell, MD, co-author of the study, told Healio.com/Orthopedics. “We sought to investigate whether dronabinol, an FDA-approved, synthetic [tetrahydrocannabinol] THC in pill form, might decrease patients’ need for opioids for pain control after total hip or total knee replacement.”

Hickernell and colleagues retrospectively compared 81 patients who underwent primary TJA and received 5 mg of dronabinol (Marinol, AbbVie Inc.) twice daily in addition to a standard multimodal pain regimen with a matched cohort of 162 patients who received only the standard regimen. Researchers collected patient demographics, length of stay, opioid morphine equivalents consumed, reports of nausea or vomiting, discharge destination, distance walked in physical therapy and VAS pain scores for both groups.

Results showed the two groups had no significant differences for age, gender, BMI, American Society of Anesthesiologists score, anesthesia type, VAS score, distance walked with physical therapy, discharge disposition or episodes of nausea or vomiting. Researchers found patients who received dronabinol experienced a significantly shorter mean length of stay of approximately 2.3 vs. 3 days in the control group. The dronabinol group also consumed significantly fewer total opioid morphine equivalents, according to results. Despite reports of fewer opioid morphine equivalents consumed per day and per length of stay on average in the dronabinol group, researches noted neither of these achieved statistical significance.

“Cannabinoid medications may, in fact, have a role in a multimodal pain control regimen after total hip or knee replacement and they may decrease the need for opioid pain medications, which is critical in the era of the opioid epidemic,” Hickernell said. “We hope that this study will lead to additional higher quality studies, including prospective randomized controlled trials, to further investigate the potential role of cannabinoids as additional tools in our non-opioid pain control armamentarium.” – by Casey Tingle

 

Disclosures: Hickernell reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.