Hospital for Special Surgery (HSS) presented findings from a pilot study on cannabidiol (CBD) use in pain management after bilateral total knee arthroplasty at the European Society of Regional Anesthesia and Pain Therapy (ESRA) Annual Meeting. The research focused on whether CBD could reduce pain and opioid requirements in patients undergoing double knee replacement surgery.
Cannabidiol, a non-intoxicating compound derived from cannabis, has limited clinical evidence supporting its role in pain relief and reducing opioid use. Currently, only one FDA-approved CBD solution exists, prescribed for specific conditions.
The HSS study followed 36 relatively healthy patients over four years. Participants were divided into three groups: one received a placebo, while the other two received either 400 milligrams or 800 milligrams of CBD. Doses were administered before surgery and then once daily for three days post-operation. Researchers tracked opioid consumption during the first 72 hours after surgery.
“These patients experience significant pain after surgery and often require high doses of opioids,” said Alexandra Sideris, PhD, Director of the Pain Prevention Research Center at HSS and one of the co-authors of the study. “We approached this study knowing that if we were going to study a cannabis constituent to try to see if there is any benefit, we need to start with a population that could significantly benefit from adding on an additional medication. It is very painful to have both knees replaced.”
According to internal HSS data, this patient group has a substantial need for improved pain control options. The study found that those who received 400 milligrams of CBD required about 30% less opioid medication compared to those who took 800 milligrams or placebo.
“What we found after completing the study is that patients who were randomized or received the 400-milligram dosage actually had 30% lower opioid requirements compared to the group receiving 800 milligrams. We found a lower dose seemed to help but the higher does did not. This suggests the importance of finding the right balance when determining the appropriate dose,” said Dr. Sideris. “CBD appears to be promising, but we have to be very careful in terms of the doses we give to patients.”
Patients given 400 milligrams also reported lower pain scores throughout all measured time points—nearly two points less than other groups—while those taking higher doses experienced more side effects such as dizziness and fatigue lasting up to a week.
“Moving forward, we are planning to pursue more studies where we hope to focus on the lower dose of 400 milligrams and include a larger cohort of patients. Our data suggests that the side effects profile and the fact that we didn’t see any signal for decreased opioid needs or pain suggests that we probably don’t want to go into 800 milligrams for designing a larger study,” said Kethy M. Jules-Elysee, MD, an anesthesiologist at HSS and one of the co-authors of the study.
The researchers emphasized continued monitoring and further long-term studies are needed before making broader recommendations regarding CBD use in post-surgical pain management.
