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International Orthopaedics

, Volume 43, Issue 2, pp 283–292 | Cite as

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

  • Shaun H. Medina
  • Vidushan Nadarajah
  • Julio J. Jauregui
  • Michael P. Smuda
  • Michael Foster
  • Sean J. Meredith
  • Jonathan D. Packer
  • R. Frank HennIIIEmail author
Original Paper

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.

Keywords

Marijuana Orthopaedic surgery Clinical characteristics Substance use 

Notes

Funding

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

Compliance with ethical standards

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).

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, MDGoogle 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 Google Scholar
  3. 3.
    Gallup AM, Newport F (2010) The Gallup poll: public opinion 2009. Rowman & Littlefield Publishers,Google Scholar
  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 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 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 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 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 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 Google Scholar
  10. 10.
    Robson P (2001) Therapeutic aspects of cannabis and cannabinoids. Br J Psychiatry 178:107–115Google 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):596–601Google Scholar
  12. 12.
    Benson MK, Bentley AM (1995) Lung disease induced by drug addiction. Thorax 50(11):1125–1127Google 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 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 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):692–693Google 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 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 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 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 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 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 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 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 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 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 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 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):703–708Google 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 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 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):13–16Google 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 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 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 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):289–294Google 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):375–380Google 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 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–e381Google 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 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 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 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 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 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 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 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 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 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 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 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):109–119Google 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 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 Google Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsUniversity of Maryland School of Medicine, University of Maryland Rehabilitation and Orthopaedic InstituteBaltimoreUSA
  2. 2.Department of Orthopaedic Surgery and Rehabilitation MedicineSUNY Downstate Medical CenterBrooklynUSA

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