Novel Protocol Reduced Use of Opioid Pain Relievers After Knee and Shoulder Surgeries

PainRelief.com Interview with:
Nicole Simunovic, MSc
On behalf of the NO PAin Principal Investigators

PainRelief.com: What is the background for this study?

Response: Orthopaedic surgeons prescribe more opioids than any other type of surgeon in North America. Opioids have the potential to be highly addictive and can cause serious harm or even death if taken in excess. The goal of our clinical study was to determine if an opioid sparing approach to postoperative pain management was safe and effective in patients undergoing arthroscopic knee and shoulder surgery.

Medical Cannabis May Be Helpful For Pain Relief in a Minority of People with Chronic Pain, But Will Not Be Effective For Most

PainRelief.com Interview with:
JASON BUSSE DC, PhD
Associate Professor
Associate Director
Michael G. DeGroote Centre for Medicinal Cannabis Research
McMaster University Medical Centre
Ontario, Canada

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Our focused clinical practice guideline was informed by 4 systematic reviews exploring benefits and harms of medical cannabis for chronic pain, the potential for cannabis to help people who live with pain to reduce their use of opioids, and patients values & preferences regarding medical cannabis for chronic pain. We found that non-inhaled medical cannabis provided small to very small improvements in pain relief, physical functioning and sleep quality compared to placebo, but did not improve mental functioning, role functioning or social functioning. Use of medical cannabis, versus placebo, also caused small increases in the risk of several transient, moderate, side effects, such as impaired attention, nausea, and drowsiness, and a larger increase in the risk of dizziness.

There was insufficient evidence to inform the risk of serious adverse events, such as motor vehicle accidents, cannabis use disorder (addiction), or suicide. We also found that patients’ attitudes towards medical cannabis show considerable variation, meaning that when presented with the same evidence different patients are likely to make different decisions about embarking on a trial of medical cannabis. Due to the close balance between modest benefits and harms, and high variability among patients’ attitudes, we made a weak recommendation to consider a trial of medical cannabis for people living with chronic pain who had not achieved sufficient relief with standard care.

A weak recommendation means that clinicians should provide chronic pain patients with the evidence for benefits and harms and help them to make a decision consistent with their patient’s values and preferences.

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