A Review of Cannabinoids for Spine Surgery Pain Found Potential Promise but Very Few Studies and Major Knowledge Gaps | Research

The takeaway

Cannabinoids may offer pain relief for spine surgery through endocannabinoid receptor mechanisms, but very few studies have examined this, with variable results on reoperation rates, complications, opioid use, and hospital stays.

Spine surgeons, anesthesiologists, pain management specialists, perioperative researchers.

Very few studies have examined cannabinoids for spine surgery pain

What the researchers found

THC and CBD interact with endocannabinoid receptors in the CNS and immune system, potentially offering pain relief. The entourage effect may enhance therapeutic impact. Few studies have analyzed cannabinoid use in spine surgery, with variable results on reoperation rates, mortality, complications, postoperative opioid use, and length of stay. Major knowledge gaps exist in dosing, timing, route, and specific outcomes.

Why it matters

Spine surgery is among the most painful surgical procedures, and opioid alternatives are urgently needed. However, the evidence base for cannabinoids in this setting is so thin that clinical recommendations are premature.

The numbers in context

No specific quantitative outcomes. "Few studies" with "variable results." Knowledge gaps noted in administration routes, timing, dosage, and specific outcomes.

How the study worked

Qualitative review of existing literature on cannabinoids in spine surgery pain management, covering mechanisms, clinical evidence, safety, and ethical considerations.

What this study cannot tell us

Very limited evidence base. No meta-analysis possible. Variable results across the few existing studies. Safety concerns (cognitive effects, cardiovascular risks, dependence potential) not well characterized in surgical populations.

How to read the evidence

Qualitative review highlighting evidence gaps. Current evidence too limited for clinical recommendations.

When this study was published

Published in 2023.

The bigger picture

The gap between mechanistic promise and clinical evidence is stark. While there are biological reasons to think cannabinoids could help with spine surgery pain, the field needs to move from theoretical potential to actual clinical trials.

Questions still open

Would preoperative or postoperative cannabinoid use reduce opioid requirements after spine surgery?
Which cannabinoid formulation and route would be most appropriate for perioperative use?

Common questions

Can cannabis help with spine surgery pain?

There are biological reasons to think it might, but very few studies have tested this and results have been variable. More research is needed before any recommendations can be made.

Should I use cannabis before or after spine surgery?

There is currently insufficient evidence to guide cannabinoid use around spine surgery. Effects on complications, opioid needs, and recovery are unknown.

Read the original research

Unlocking the Healing Potential: Cannabinoids in Spine Surgery for Pain Relief and Recovery.

JBJS reviews, 11(11), e23.00141

View on PubMed ↗

Citation

Shahzad, Hania; Lee, Maximillian; Munjal, Vikas; Veliky, Cole; Yu, Elizabeth. (2023). Unlocking the Healing Potential: Cannabinoids in Spine Surgery for Pain Relief and Recovery.. JBJS reviews, 11(11), e23.00141.