Is Cannabis an Effective Painkiller After Major Surgery?
How effective is cannabis at relieving post-surgery pain? And how does it stack up against opioids and other pain medications in terms of effectiveness, accessibility, and side effects? Read on to learn more.
These days, cannabis has many applications. Apart from its usual recreational purposes, the magic herb has been credited anecdotally and scientifically for its potential health and wellness-promoting attributes. Just by looking at published research over the last few decades, you’ll find a lot of literature on it.
For this article, we’ll talk about how cannabis could be effective for pain relief after major surgery. Is it a better alternative to over-the-counter medication? Or are we better off with opioids and other pharmaceutical drugs?
We’ll delve into this topic by going through what the scientific research says, as well as the other options people opt for. If you’re considering CBD or THC to alleviate your post-op pain, this piece should begin to answer your questions.
Current Treatments for Post-Surgery Pain
Not all surgeries are a smooth process. Some procedures are a bit rough, but you end up doing fine afterward; other surgeries will leave you aching like you just went through a six-round boxing match.
Before cannabis legalization, and still today, doctors were inclined to prescribe more traditional options for pain relief; some of them drug-induced, others not.
The type of treatment one undergoes depends on the type of surgery, as well as one’s pain tolerance. Most of these forms of treatment are generally safe, save from some side effects like nausea, drowsiness, and vomiting.
Anesthetics numb a particular portion of the body for a short period of time. Some of them can be taken orally, while others come in the form of a topical medication.
In some cases, nerve blocks are offered to patients who find their pain to be unbearable. Similar to most anesthetics, a nerve block desensitises the particular region of the body from which the pain radiates. It is usually administered through a catheter.
What’s great about nerve blocks is that they lessen the amount of opioid medication administered. That means fewer, less intense episodes of nausea, drowsiness, and other side effects.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
You’ve likely taken some ibuprofen for a really bad toothache or some celecoxib to rid yourself of a migraine.
All of these are nonsteroidal anti-inflammatory drugs (otherwise known as NSAIDs), and, as the name suggests, are used primarily to reduce inflammation. You can purchase them even without a prescription.
The main advantage of taking NSAIDs is that they do not cause any impairment. But there are possible side effects like dizziness and stomach issues to consider. They can also pose a problem for those suffering from stomach ulcers or those taking blood thinners.
Even with the accessibility of NSAIDs, it would still be best to consult a professional before using them.
For those who aren’t a fan of loading their bodies with drugs, there are relaxation techniques to help alleviate post-surgery pain.
One good example is guided imagery, wherein you draw up a calm, soothing image in your mind. The purpose of this technique is to provide you with a pleasant distraction from the pain, therefore reducing its intensity.
Homeopathic remedies like cold or heat therapy also work to reduce the swelling and make the pain more manageable. As for which one to go with, it will depend on the advice of your doctor or practitioner.
If you’re dealing with mild to moderate pain that you no longer want to feel, analgesics are the way to go. They are often effective on their own and lessen the need to take other medications, thus reducing the potential for side effects.
Like NSAIDs, most analgesics are safe for consumption. You can purchase them from your local drug store without the need for a prescription.
One thing you will have to watch out for, however, is possible liver damage if you go over the prescribed dosage. If you’re already dealing with pre-existing liver problems, you will need to consult a doctor beforehand.
Opioids for Post-Surgery Pain Relief
Certain opioids are commonly used to relieve post-surgery pain. Those experiencing intense pain are usually prescribed these medications.
Upon taking these drugs, they bind with opioid receptors in the brain and spinal cord. Signals are then sent through the entire body, telling it that it’s not in pain.
The biggest advantage of taking opioids for pain relief is that the effects are immediate. Agony is replaced by a distinct euphoric feeling.
But, like any other synthetic drug, the drawbacks are punishing, especially when abused.
Physical Side Effects of Opioids
The first few tell-tale signs of opioid dependence are the physical side effects. A few people experience drowsiness, while others go through bouts of constipation.
Some may brush them off as a normal occurrence, but experiencing these symptoms first-hand will tell you that something is not right with your body.
Tolerance and Withdrawal
The more frequently you take opioids, the easier it is for your body to build a high tolerance to them. So, what do you do? You increase your dosage to unhealthy levels to feel something.
The withdrawal symptoms after you quit aren’t at all fun. They involve muscle pain, nausea and vomiting, and abdominal cramps, just to name a few.
Now you’re in an ugly irony wherein the drugs that are supposed to provide you relief are actually causing you these excruciatingly uncomfortable moments.
Mental and Behavioural Changes
Prolonged opioid use will lead to the body’s dependence on these drugs. The brain stops its production of certain hormones and neurochemicals, and instead relies on the opioids to do the work.
The result? The brain also begins to respond to the environment differently. Certain cues and triggers may remind the person about the drug, which ultimately builds up an unwanted craving.
That dependence also tends to lead to desperate acts just to get the fix. It could be stealing money from family members or other crooked acts.
What Does Research Say About Cannabis for Pain?
Now, let’s get into the meat of the matter. How exactly does science view medical cannabis for post-surgery pain?
As it is with other findings on cannabis, experts have found some positives and some negatives.
Medical Cannabis for Pain Control
In one study conducted in 2008  , researchers found a connection between cannabis and pain control. The link? Our body’s endocannabinoid system.
See, when THC enters the body, it binds with CB1 and CB2 receptors within the ECS. The activation of these receptors has the potential to produce anti-inflammatory effects that relieve pain and reduce hyperalgesia (abnormally heightened pain sensitivity). Those who suffer from fibromyalgia and migraine are all too familiar with it.
That’s not all. THC can also modulate both dopamine and serotonin levels, which could also help in pain reduction.
CBD, a non-psychotropic compound, also displays efficacy as a potential anti-inflammatory  compound through its indirect action on the ECS. The full scope of CBD’s analgesic potential is up for debate, but it hints at the possible effectiveness of full-spectrum cannabis therapeutics.
Medical Cannabis to Lower Painkiller Use?
The opioids themselves aren’t the only issue. Another major issue is the accessibility to such drugs, and the ease with which they can be misused and abused.
However, recent studies  show how medical cannabis could potentially lower the likelihood of opioid use. One study observed that 82% of 1,000 respondents taking cannabis to manage pain were able to either reduce or completely stop taking over-the-counter pain medication. Another 88% were able to quit opioid painkillers completely.
In some cases, people resort to medical cannabis to avoid the unpleasant side effects brought on by certain medications. But, ultimately, controlled use of marijuana for therapeutic purposes allows patients to experience relief without opioids. Therefore, the chances of developing a tolerance and dependence are significantly lessened.
Medical Cannabis as a Possible Gateway to Opioid Use
On the flip side, the negatives of medical cannabis use also need to be taken into account. As this 2016 retroactive pilot study  shows, chronic marijuana consumption may lead to eventual opioid use.
The study involved motor vehicle crash patients in Colorado and Texas hospitals, and ultimately concluded that chronic cannabis use possibly affects the pain response by requiring higher doses of analgesic opioids to achieve relief.
However, it is worth noting that these findings were specifically seen in chronic users. Episodic users showed no differences in their desire to use opioids.
Is cannabis an effective painkiller following surgery? And, if so, how does it compare to traditional medications like opioids? Find out more inside.
CBD Oil Before / After Surgery Safe?
While some states are slowly adopting more lenient laws regarding the recreational use of marijuana, it is a byproduct of this plant that seems to be taking the country by storm. Whether it is tinctures to manage physical pain and anxiety, or topical creams and smokeable “joints,” CBD appears to be the latest “cure-all” craze—and users are flocking to pharmacies and pop-up dispensaries in droves.
CBD is considered to be generally safe by many, but the popularity of the product has far surpassed current regulation. Unregulated, synthetic products should be avoided entirely and even regulated CBD should not be taken immediately before or after surgery.
As a physician, I must weigh the popularity vs. the published research for medical and health-related products. While CBD oil does appear to have potential as an effective treatment for some people, it’s important to know the possible risks before using or consuming CBD.
I have recently had some patients ask about using CBD oil before and after elective surgery, and I want to clear a few things up to ensure that patients have a safe surgery and recovery.
What is CBD?
Cannabidiol (CBD) is one of the main extracts of the marijuana plant, second only to tetrahydrocannabinol (THC, the psychoactive component of marijuana). While it has experienced a boom in popularity over the last few years, this derivative from the hemp plant has a long history, with documentation of therapeutic use dating back to 2737 BC.
There are a number of studies that suggest that CBD can be a powerful alternative for managing epilepsy, insomnia, and mental health disorders, however, the popularity of the product has far surpassed current research on its effectiveness.
Is CBD legal in Texas?
Earlier this summer, Governor Greg Abbott signed a bill making the production of hemp and hemp-derived CBD legal in Texas. While producing and purchasing CBD products is now technically legal, many available products are still unregulated and could contain more or less CBD than advertised, have undisclosed ingredients, or could be concocted with synthetic cannabinoids. Commonly found in gas stations and convenience stores, synthetic cannabinoids are completely unregulated and pose significant risks.
CBD may now be legal, but that doesn’t mean it’s safe: the FDA has issued a warning about synthetic, contaminated CBD products.
Just because a product is legal does not mean it is guaranteed to be safe. The FDA released a warning last year about the health risks of synthetic cannabinoid products, which were found to be contaminated with the rat poison brodifacoum. After ingesting these products, many people experienced vomiting, increased heart rate and blood pressure, and even violent behavior and suicidal thoughts. Synthetic cannabinoids have now been linked to severe, uncontrolled bleeding and death. Hundreds of people across several states have been affected negatively by CBD products.
Should I stop taking CBD before cosmetic surgery?
CBD is used widely in the self-management of pain and anxiety, so many patients wonder if they can ingest CBD oil drops or tinctures before their cosmetic procedure and during their recovery. CBD products should not be taken in the days before or after surgery.
We have an incomplete understanding of how CBD interacts with other medications and how it may impact our body systems, but research has found that it has an anticoagulant effect, which puts patients at risk for increased bleeding during and after surgery. Abundant or easy bleeding after surgery can result in the need to return for another, unanticipated surgery to correct the bleeding problems, asymmetry, and tissue death after surgery.
Just as I ask patients to stop taking herbal supplements, vitamins, and nicotine (and even seemingly harmless beverages like green tea) to ensure there are no problems with anesthesia or increased bleeding, CBD products should be stopped two weeks prior to surgery.
CBD products also have a potent reaction with an enzyme system in the liver that can prevent other medications—such as anesthesia medications or prescription pain killers—from using the same system, leading to a build-up in your system and preventing the medications from doing their job.
The unregulated nature of CBD means that dosing has not been defined and that different brands offer a wide variety of strengths available for purchase. The current state of the CBD industry is like the wild west of supplements, and without truly scientific data, we must err on the side of caution.
Can I smoke weed before surgery?
I encourage patients not to smoke anything before a procedure. Many patients falsely believe that smoking marijuana is a safer choice than cigarettes, which is not true—particularly when it comes to surgery. Smoke of any kind in the lungs can lead to respiratory distress, and marijuana itself can interfere with anesthesia, leading to a higher risk of pneumonia after surgery and a higher risk of airway emergencies. Much like nicotine, smoking marijuana before or after surgery delays the healing process and causes poor scarring of your surgical sites. If you live somewhere where marijuana is legal, edibles are a better choice for eliminating the respiratory problems, however, be sure not to eat past the allowed time before surgery.
It’s crucial to be transparent with your physician; we’re not here to judge, but rather to keep you safe
Before any procedure, it’s important that you share any medications, herbal supplements, or vitamins you take regularly with your surgeon, in addition to information about lifestyle habits like drinking, smoking, and drug use.
As a board certified plastic surgeon, my job is not to pass judgment on your personal decisions or lecture you. However, once you are in my operating room, my ability to perform your procedure safely is very much affected by what you put in your body and whether or not you share that information with me. Something as seemingly innocent as CBD oil drops can lead to surgical complications that can, in turn, impact your wellbeing and your results.
If you are ever unsure about what you can or cannot take prior to surgery, please contact your surgeon for their specific pre-op and post-op instructions.
Wondering if CBD is safe to use before & after surgery? Board certified plastic surgeon Dr. Emily Kirby explains why you may need to rethink this popular product.