Orthopaedic surgery patients who use recreational marijuana have less pre-operative pain

Abstract

Aims

To determine the baseline clinical characteristics of recreational marijuana users undergoing outpatient orthopaedic surgery. We hypothesized that patients who report marijuana use would have worse pain, function, and general health status.

Patients and methods

Nine-hundred and thirty-seven patients undergoing outpatient orthopaedic surgery were asked to fill out patient-reported outcome (PRO) tools. These PROs included the Patient-Reported Outcomes Measurement Information Systems (PROMIS) computer adaptive tests and legacy PROs unique to each patients’ surgical site.

Results

Forty patients (4.2%) reported marijuana use. Marijuana use was associated with younger age (33 vs. 43 years, p < 0.001), having a history of fewer operations (1.8 vs. 3.2, p < 0.05), single marital status (68 vs. 38%, p < 0.01), and having a history of smoking cigarettes (63 vs. 31%, p < 0.0001). Marijuana use was found to be significantly associated with greater Marx lower extremity activity rating scale scores (8.5 points vs. 6.1 points, p < 0.05) and decreased pain intensity in the operative site (3.7 points vs. 5.0 points, p < 0.05). Multivariable analysis found that marijuana use was an independent factor associated with less pain intensity in the operative site (p < 0.05).

Conclusion

Our studies support other national studies that report increased marijuana use among younger patients and those who smoke cigarettes. The results do not support our hypothesis, as marijuana use was associated with less pain and better lower extremity activity rating scale scores when compared to non-users. Further research is warranted to analyze the effects of marijuana use on orthopaedic surgery patients.

Study design

Cross-sectional study.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Substance Abuse Mental Health Services Administration (“SAMHSA”) (2007a) Results from the 2006 National Survey on drug use and health: National Findings (2010). SAMHSA, Rockville, MD

    Google Scholar 

  2. 2.

    Cerda M, Wall M, Keyes KM, Galea S, Hasin D (2012) Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug Alcohol Depend 120(1–3):22–27. https://doi.org/10.1016/j.drugalcdep.2011.06.011

    Article  PubMed  Google Scholar 

  3. 3.

    Gallup AM, Newport F (2010) The Gallup poll: public opinion 2009. Rowman & Littlefield Publishers,

  4. 4.

    Phillips TJ, Cherry CL, Cox S, Marshall SJ, Rice AS (2010) Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials. PLoS One 5(12):e14433. https://doi.org/10.1371/journal.pone.0014433

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Martin-Sanchez E, Furukawa TA, Taylor J, Martin JL (2009) Systematic review and meta-analysis of cannabis treatment for chronic pain. Pain Med 10(8):1353–1368. https://doi.org/10.1111/j.1526-4637.2009.00703.x

    Article  Google Scholar 

  6. 6.

    Machado Rocha FC, Stefano SC, De Cassia HR, Rosa Oliveira LM, Da Silveira DX (2008) Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur J Cancer Care (Engl) 17(5):431–443. https://doi.org/10.1111/j.1365-2354.2008.00917.x

    CAS  Article  Google Scholar 

  7. 7.

    Flachenecker P (2013) A new multiple sclerosis spasticity treatment option: effect in everyday clinical practice and cost-effectiveness in Germany. Expert Rev Neurother 13(3 Suppl 1):15–19. https://doi.org/10.1586/ern.13.1

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Jensen B, Chen J, Furnish T, Wallace M (2015) Medical marijuana and chronic pain: a review of basic science and clinical evidence. Curr Pain Headache Rep 19(10):50. https://doi.org/10.1007/s11916-015-0524-x

    Article  PubMed  Google Scholar 

  9. 9.

    Lynch ME, Campbell F (2011) Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Clin Pharmacol 72(5):735–744. https://doi.org/10.1111/j.1365-2125.2011.03970.x

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Robson P (2001) Therapeutic aspects of cannabis and cannabinoids. Br J Psychiatry 178:107–115

    CAS  Article  Google Scholar 

  11. 11.

    Polen MR, Sidney S, Tekawa IS, Sadler M, Friedman GD (1993) Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med 158(6):596–601

    CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Benson MK, Bentley AM (1995) Lung disease induced by drug addiction. Thorax 50(11):1125–1127

    CAS  Article  Google Scholar 

  13. 13.

    Sridhar KS, Raub WA Jr, Weatherby NL, Metsch LR, Surratt HL, Inciardi JA, Duncan RC, Anwyl RS, McCoy CB (1994) Possible role of marijuana smoking as a carcinogen in the development of lung cancer at a young age. J Psychoactive Drugs 26(3):285–288. https://doi.org/10.1080/02791072.1994.10472442

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Flisberg P, Paech MJ, Shah T, Ledowski T, Kurowski I, Parsons R (2009) Induction dose of propofol in patients using cannabis. Eur J Anaesthesiol 26(3):192–195. https://doi.org/10.1097/EJA.0b013e328319be59

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Lawson TM, Rees A (1996) Stroke and transient ischaemic attacks in association with substance abuse in a young man. Postgrad Med J 72(853):692–693

    CAS  Article  Google Scholar 

  16. 16.

    Mallat A, Roberson J, Brock-Utne JG (1996) Preoperative marijuana inhalation—an airway concern. Can J Anaesth 43(7):691–693. https://doi.org/10.1007/BF03017953

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Heng M, McTague MF, Lucas RC, Harris MB, Vrahas MS, Weaver MJ (2018) Patient perceptions of the use of medical marijuana in the treatment of pain after musculoskeletal trauma: a survey of patients at 2 trauma centers in Massachusetts. J Orthop Trauma 32(1):e25–e30. https://doi.org/10.1097/BOT.0000000000001002

    Article  PubMed  Google Scholar 

  18. 18.

    Henn RF 3rd, Dubina AG, Jauregui JJ, Smuda MP, Tracy JK (2017) The Maryland Orthopaedic Registry (MOR): design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 8(4):301–307. https://doi.org/10.1016/j.jcot.2017.04.003

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Iannotti JP, Deutsch A, Green A, Rudicel S, Christensen J, Marraffino S, Rodeo S (2013) Time to failure after rotator cuff repair: a prospective imaging study. J Bone Joint Surg Am 95(11):965–971. https://doi.org/10.2106/JBJS.L.00708

    Article  PubMed  Google Scholar 

  20. 20.

    Bartl C, Kouloumentas P, Holzapfel K, Eichhorn S, Wortler K, Imhoff A, Salzmann GM (2012) Long-term outcome and structural integrity following open repair of massive rotator cuff tears. Int J Shoulder Surg 6(1):1–8. https://doi.org/10.4103/0973-6042.94304

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Agrawal A, Lynskey MT (2009) Tobacco and cannabis co-occurrence: does route of administration matter? Drug Alcohol Depend 99(1–3):240–247. https://doi.org/10.1016/j.drugalcdep.2008.08.007

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Weinberger AH, Funk AP, Goodwin RD (2016) A review of epidemiologic research on smoking behavior among persons with alcohol and illicit substance use disorders. Prev Med 92:148–159. https://doi.org/10.1016/j.ypmed.2016.05.011

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Schauer GL, Berg CJ, Kegler MC, Donovan DM, Windle M (2015) Assessing the overlap between tobacco and marijuana: trends in patterns of co-use of tobacco and marijuana in adults from 2003-2012. Addict Behav 49:26–32. https://doi.org/10.1016/j.addbeh.2015.05.012

    Article  PubMed  Google Scholar 

  24. 24.

    Hindocha C, Shaban ND, Freeman TP, Das RK, Gale G, Schafer G, Falconer CJ, Morgan CJ, Curran HV (2015) Associations between cigarette smoking and cannabis dependence: a longitudinal study of young cannabis users in the United Kingdom. Drug Alcohol Depend 148:165–171. https://doi.org/10.1016/j.drugalcdep.2015.01.004

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Ramo DE, Liu H, Prochaska JJ (2012) Tobacco and marijuana use among adolescents and young adults: a systematic review of their co-use. Clin Psychol Rev 32(2):105–121. https://doi.org/10.1016/j.cpr.2011.12.002

    Article  PubMed  Google Scholar 

  26. 26.

    Goodwin RD, Sheffer CE, Chartrand H, Bhaskaran J, Hart CL, Sareen J, Bolton J (2014) Drug use, abuse, and dependence and the persistence of nicotine dependence. Nicotine Tob Res 16(12):1606–1612. https://doi.org/10.1093/ntr/ntu115

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Prudius D, Weber P, Matejovska Kubesova H, Meluzinova H, Polcarova V, Bielakova K (2017) Pulmonary embolism in the hospitalized patients 65+ in relation to presence of diabetes in 2007-2015. Adv Gerontol 30(5):703–708

    CAS  PubMed  Google Scholar 

  28. 28.

    Goodwin RD, Pacek LR, Copeland J, Moeller SJ, Dierker L, Weinberger A, Gbedemah M, Zvolensky MJ, Wall MM, Hasin DS (2018) Trends in daily cannabis use among cigarette smokers: United States, 2002-2014. Am J Public Health 108(1):137–142. https://doi.org/10.2105/AJPH.2017.304050

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Bryson EO, Frost EA (2011) The perioperative implications of tobacco, marijuana, and other inhaled toxins. Int Anesthesiol Clin 49(1):103–118. https://doi.org/10.1097/AIA.0b013e3181dd4f53

    Article  PubMed  Google Scholar 

  30. 30.

    Campbell FA, Tramer MR, Carroll D, Reynolds DJ, Moore RA, McQuay HJ (2001) Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. BMJ 323(7303):13–16

    CAS  Article  Google Scholar 

  31. 31.

    Fitzcharles MA, Baerwald C, Ablin J, Hauser W (2016) Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials. Schmerz 30(1):47–61. https://doi.org/10.1007/s00482-015-0084-3

    Article  Google Scholar 

  32. 32.

    Hill KP (2015) Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA 313(24):2474–2483. https://doi.org/10.1001/jama.2015.6199

    CAS  Article  Google Scholar 

  33. 33.

    Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J (2015) Cannabinoids for medical use: a systematic review and meta-analysis. Jama 313(24):2456–2473. https://doi.org/10.1001/jama.2015.6358

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Jamison RN, Sbrocco T, Parris WC (1989) The influence of physical and psychosocial factors on accuracy of memory for pain in chronic pain patients. Pain 37(3):289–294

    CAS  Article  Google Scholar 

  35. 35.

    Eich E, Reeves JL, Jaeger B, Graff-Radford SB (1985) Memory for pain: relation between past and present pain intensity. Pain 23(4):375–380

    CAS  Article  Google Scholar 

  36. 36.

    Bernstein DN, Sood A, Mellema JJ, Li Y, Ring D (2017) Lifetime prevalence of and factors associated with non-traumatic musculoskeletal pains amongst surgeons and patients. Int Orthop 41(1):31–38. https://doi.org/10.1007/s00264-016-3338-5

    Article  PubMed  Google Scholar 

  37. 37.

    Deshpande A, Mailis-Gagnon A, Zoheiry N, Lakha SF (2015) Efficacy and adverse effects of medical marijuana for chronic noncancer pain: systematic review of randomized controlled trials. Can Fam Physician 61(8):e372–e381

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Pritchett JW (2018) Outcome of surgery for nerve injury following total hip arthroplasty. Int Orthop 42(2):289–295. https://doi.org/10.1007/s00264-017-3724-7

    Article  PubMed  Google Scholar 

  39. 39.

    Andrei D, Popa I, Brad S, Iancu A, Oprea M, Vasilian C, Poenaru DV (2017) The variability of vertebral body volume and pain associated with osteoporotic vertebral fractures: conservative treatment versus percutaneous transpedicular vertebroplasty. Int Orthop 41(5):963–968. https://doi.org/10.1007/s00264-017-3409-2

    Article  PubMed  Google Scholar 

  40. 40.

    Motififard M, Omidian A, Badiei S (2017) Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial. Int Orthop 41(5):939–947. https://doi.org/10.1007/s00264-016-3357-2

    Article  PubMed  Google Scholar 

  41. 41.

    Li D, Tan Z, Kang P, Shen B, Pei F (2017) Effects of multi-site infiltration analgesia on pain management and early rehabilitation compared with femoral nerve or adductor canal block for patients undergoing total knee arthroplasty: a prospective randomized controlled trial. Int Orthop 41(1):75–83. https://doi.org/10.1007/s00264-016-3278-0

    Article  PubMed  Google Scholar 

  42. 42.

    Song MH, Kim BH, Ahn SJ, Yoo SH, Kang SW, Kim YJ, Kim DH (2016) Peri-articular injections of local anaesthesia can replace patient-controlled analgesia after total knee arthroplasty: a randomised controlled study. Int Orthop 40(2):295–299. https://doi.org/10.1007/s00264-015-2940-2

    Article  PubMed  Google Scholar 

  43. 43.

    Menendez ME, Ring D, Bateman BT (2015) Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res 473(7):2402–2412. https://doi.org/10.1007/s11999-015-4173-5

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Rozell JC, Courtney PM, Dattilo JR, Wu CH, Lee GC (2017) Preoperative opiate use independently predicts narcotic consumption and complications after total joint arthroplasty. J Arthroplast 32(9):2658–2662. https://doi.org/10.1016/j.arth.2017.04.002

    Article  Google Scholar 

  45. 45.

    Bachhuber MA, Saloner B, Cunningham CO, Barry CL (2014) Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med 174(10):1668–1673. https://doi.org/10.1001/jamainternmed.2014.4005

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Gable RS (2004) Comparison of acute lethal toxicity of commonly abused psychoactive substances. Addiction 99(6):686–696. https://doi.org/10.1111/j.1360-0443.2004.00744.x

    Article  PubMed  Google Scholar 

  47. 47.

    Hall W, Degenhardt L (2009) Adverse health effects of non-medical cannabis use. Lancet 374(9698):1383–1391. https://doi.org/10.1016/S0140-6736(09)61037-0

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Lopez-Quintero C, de los Perez CJ, Hasin DS, Okuda M, Wang S, Grant BF, Blanco C (2011) Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 115(1–2):120–130. https://doi.org/10.1016/j.drugalcdep.2010.11.004

    Article  PubMed  Google Scholar 

  49. 49.

    Ramaekers JG, Berghaus G, van Laar M, Drummer OH (2004) Dose related risk of motor vehicle crashes after cannabis use. Drug Alcohol Depend 73(2):109–119

    CAS  Article  Google Scholar 

  50. 50.

    Brady JE, Li G (2014) Trends in alcohol and other drugs detected in fatally injured drivers in the United States, 1999-2010. Am J Epidemiol 179(6):692–699. https://doi.org/10.1093/aje/kwt327

    Article  PubMed  PubMed Central  Google Scholar 

  51. 51.

    Volkow ND, Baler RD, Compton WM, Weiss SR (2014) Adverse health effects of marijuana use. N Engl J Med 370(23):2219–2227. https://doi.org/10.1056/NEJMra1402309

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by a grant from The James Lawrence Kernan Hospital Endowment Fund, Incorporated.

Author information

Affiliations

Authors

Corresponding author

Correspondence to R. Frank Henn III.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Approval

This study was approved by the Institutional Review Board (IRB) Committee at the University of Maryland, Baltimore (HP-00062261).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Medina, S.H., Nadarajah, V., Jauregui, J.J. et al. Orthopaedic surgery patients who use recreational marijuana have less pre-operative pain. International Orthopaedics (SICOT) 43, 283–292 (2019). https://doi.org/10.1007/s00264-018-4101-x

Download citation

Keywords

  • Marijuana
  • Orthopaedic surgery
  • Clinical characteristics
  • Substance use