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Cannabis and CBD for Pain

What the evidence does and doesn't show for cannabis and CBD in musculoskeletal pain, and practical and safety considerations.

26 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Current evidence demonstrates efficacy and safety for chronic musculoskeletal and neuropathic pain [23]. However, definitive conclusions regarding the efficacy of medical cannabis in hand and upper extremity conditions require continued investigation [23]. In patients with traumatic brachial plexus injuries, cannabis-based medicine did not provide clinical improvement in pain compared with a placebo [1]. A randomized controlled trial found no clinically important benefit to cannabis-based treatment as an adjuvant to standard multimodal drug therapy for neuropathic pain in these injuries [15]. Conversely, findings suggest the applicability of cannabis-based medicines for peripheral neuropathy [5].

Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome after arthroscopic rotator cuff repair [3]. This lack of long-term detrimental effects after arthroscopic rotator cuff repair has been further supported [4]. A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management [9]. Most survey respondents in the orthopaedic sports medicine community believed that CBD has a role in postoperative and chronic pain management [10].

Patient perception varies by condition. Patients estimated medical cannabis could treat more than half of their spine pain [8]. One in three patients with spine pain were already using medical cannabis [8]. 79% of patients with spine pain believe cannabis could reduce opioid usage [8]. 89% of participants considered medical cannabis to be more effective than narcotics for adequate pain management [6]. Large numbers of patients with osteoarthritis of the thumb basal joint would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their pain [11]. 80.9% of patients presenting for hand and upper-extremity complaints would consider using medical cannabis [12]. Patients presenting for hand and upper-extremity complaints perceive medical cannabis as a safe treatment option for common orthopedic conditions [12]. Cost is identified as a major barrier to the use of medical cannabis by patients presenting for hand and upper-extremity complaints [12].

How It Works

CBD integrates into postoperative multimodal pain management regimens without detrimental effects on outcome [3] or long-term detrimental effects [4]. Specifically, buccally absorbed CBD demonstrates an acceptable safety profile and shows significant promise in reducing pain in the immediate peri-operative period following arthroscopic rotator cuff repair compared to control [18]. While cannabis-based medicines have applicability for peripheral neuropathy [5], cannabis-based treatment showed no clinically important benefit as an adjuvant to standard multimodal drug therapy for neuropathic pain in traumatic brachial plexus injuries [15].

Clinical Guidance and Research Gaps: More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance for patients seeking advice for this therapeutic [17]. Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after total hip arthroplasty to help guide orthopaedic surgeons in counseling patients [19].

Patient and Biological Interactions: Patient perceptions of marijuana use are variable, with more patients comfortable with their physician using marijuana outside of work than not [21]. The absence of statistically significant additive effects between cannabis and nicotine use may reflect limited power to detect modest interactions, overlapping biological mechanisms, or a true absence of synergy [22].

What the Evidence Shows

Efficacy and Outcomes

Cannabidiol (CBD) can be incorporated into a postoperative multimodal pain management regimen following arthroscopic rotator cuff repair without detrimental effects on outcome [3]. This approach is supported by evidence indicating no long-term detrimental effects on outcomes in this specific surgical context [4]. For broader musculoskeletal and neuropathic pain, current evidence demonstrates efficacy and safety for cannabinoids; however, definitive conclusions regarding efficacy in hand and upper extremity conditions require continued investigation [23]. Systematic review findings suggest the applicability of cannabis-based medicines for peripheral neuropathy [5].

Safety and Complications

The absence of statistically significant additive effects between cannabis and nicotine use regarding adverse outcomes following upper extremity fracture fixation may reflect limited power to detect modest interactions, overlapping biological mechanisms, or a true absence of synergy [22].

Patient and Surgeon Perceptions

Most patients presenting for hand and upper-extremity complaints would consider using medical cannabis (80.9%) [12]. Furthermore, most of these patients perceive medical cannabis as a safe treatment option for common orthopedic conditions [12].

Specific Populations and Procedures

In adolescents and young adults undergoing hip arthroscopy for femoracetabular impingement, there is no evidence that preoperative marijuana use affects pain levels, narcotic requirements, or functional outcomes [25]. These patients showed marked improvements after hip arthroscopy regardless of preoperative marijuana use [25]. In pediatric and adolescent patients undergoing anterior cruciate ligament reconstruction, positive self-reported marijuana attestation was associated with higher rates of overnight admission for pain [26]. This attestation was also associated with prolonged time to return to sport [26]. Among patients undergoing arthroscopic procedures, those who self-report cannabis use are significantly younger than those who do not report cannabis use [24]. Additionally, patients who self-report cannabis use are more likely to be male than those who do not report cannabis use [24].

Practical Considerations

Demographics and Research Gaps

Patients undergoing arthroscopic procedures who self-report cannabis use are significantly younger and more likely to be male compared to those who do not report cannabis use [24].

Key Evidence

  • [L1] Cannabis-based medicine did not provide clinical improvement in pain compared with a placebo in patients with traumatic brachial plexus injuries. [1] (10.1097/corr.0000000000003221)
  • [L2] Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures. [2] (10.1016/j.jhsg.2026.100948)
  • [L2] These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. [3] (10.1177/23259671231222265)
  • [L2] These findings suggest that CBD can be considered in a post-operative multimodal pain management regimen without long-term detrimental effects. [4] (10.1177/2325967123s00172)
  • [L2] These findings suggest the applicability of cannabis-based medicines for peripheral neuropathy. [5] (10.1016/j.jhsa.2024.09.015)
  • [L4] In addition, 89% of the participants considered medical cannabis to be more effective than narcotics for adequate pain management. [6] (10.5435/jaaosglobal-d-22-00055)
  • [Paper] Regular cannabis use may be associated with increased opioid usage in the context of total joint arthroplasty, and no specific guidance in the use of cannabis in perioperative pain management can be suggested based on this discovery. [7] (10.1097/corr.0000000000003472)
  • [L4] Patients estimated medical cannabis could treat more than half of their spine pain, with one in three patients already using medical cannabis, and 79% of patients believe cannabis could reduce opioid usage. [8] (10.1186/s13018-024-04558-6)
  • [L4] A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management. [9] (10.1177/2325967123s00336)
  • [L4] Most survey respondents believed that CBD has a role in postoperative and chronic pain management. [10] (10.1177/23259671231191766)
  • [L4] Large numbers of these patients would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their thumb basal joint pain. [11] (10.1016/j.jhsa.2021.10.018)
  • [L3] Most patients presenting for hand and upper-extremity complaints would consider using medical cannabis (80.9%) and perceive it as a safe treatment option for common orthopedic conditions, with cost identified as a major barrier to use. [12] (10.1016/j.jhsg.2022.02.009)
  • [L1] Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing TJA. [13] (10.1016/j.arth.2023.07.008)
  • [L1] Despite enthusiasm for cannabis after orthopaedic surgical procedures, this THC does not appear to limit opioid intake after primary TKA. [14] (10.1016/j.arth.2026.02.047)
  • [Paper] This is a commentary on a randomized controlled trial by Kittithamvongs et al., which found no clinically important benefit to cannabis-based treatment as an adjuvant to standard multimodal drug therapy for neuropathic pain in traumatic brachial plexus injuries. [15] (10.1097/corr.0000000000003265)
  • [L3] The use of THC increases the risk of more morphine milligram equivalents (MMEs) needed in the postoperative spine period, especially if those patients were on opiates as well together. [16] (10.5435/jaaosglobal-d-23-00206)
  • [L4] More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance for patients seeking advice for this recently popular therapeutic. [17] (10.5435/jaaosglobal-d-21-00047)
  • [L1] Buccally absorbed CBD demonstrates an acceptable safety profile and shows significant promise in reduction of pain in the immediate peri-operative period following ARCR compared to the control. [18] (10.1016/j.jse.2023.02.032)
  • [L3] Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after THA to help guide orthopaedic surgeons in counseling patients. [19] (10.1016/j.arth.2023.03.040)
  • [L3] We did not identify differences with respect to medical marijuana legalization implementation. [20] (10.1097/corr.0000000000003422)
  • [L4] Patient perceptions of marijuana use are variable, with more patients comfortable with their physician using marijuana outside of work than not. [21] (10.1016/j.jhsg.2024.11.010)
  • [L3] The absence of statistically significant additive effects may reflect limited power to detect modest interactions, overlapping biological mechanisms, or a true absence of synergy. [22] (10.1186/s13018-025-06635-w)
  • [L4] Current evidence demonstrates efficacy and safety for chronic musculoskeletal and neuropathic pain, but definitive conclusions regarding efficacy in hand and upper extremity conditions require continued investigation. [23] (10.1016/j.jhsa.2022.11.008)
  • [L4] Patients undergoing arthroscopic procedures self-reporting cannabis use are significantly younger and more likely to be male compared to those who do not report cannabis use. [24] (10.1177/2325967126s00487)
  • [L2] Adolescents and young adults showed marked improvements after hip arthroscopy regardless of preoperative marijuana use, with no evidence that preoperative marijuana use affects pain levels, narcotic requirements, or functional outcomes. [25] (10.1177/23259671251385152)
  • [L3] Positive self-reported marijuana attestation in pediatric and adolescent patients undergoing ACLR was associated with higher rates of overnight admission for pain and prolonged time to RTS, suggesting potential implications for perioperative management and recovery. [26] (10.1177/23259671251369015)

See Also

  • Osteoarthritis

References

[1] Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003221

[2] Is Cannabis Dependence Associated with Postoperative Infections in Hand and Wrist Surgeries?. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100948

[3] Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671231222265

[4] Poster 186: Cannabidiol for Post-Operative Pain Control after Arthroscopic Rotator Cuff Repair Demonstrates No Functional Deficits at 1-Year. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00172

[5] The Use of Cannabinoids in the Treatment of Peripheral Neuropathy and Neuropathic Pain: A Systematic Review. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.015

[6] Patient Experience and Perspective on Medical Cannabis as an Alternative for Musculoskeletal Pain Management. JAAOS: Global Research and Reviews. 2022. DOI: 10.5435/jaaosglobal-d-22-00055

[7] CORR Insights®: Do Medical and Recreational Marijuana State Laws Impact Trends in Postoperative Opioid Prescriptions Among Patients Who Have Undergone TJA?. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003472

[8] Perceptions in orthopedic surgery on the use of cannabis in treating pain: a survey of patients with spine pain (POSIT Spine). Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04558-6

[9] Poster 373: Perceptions & Opinions on Cannabidiol Among Sports Medicine Orthopaedic Surgeons. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00336

[10] Perceptions and Opinions on Cannabidiol in the Orthopaedic Sports Medicine Community. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231191766

[11] Assessment of Medical Cannabis in Patients With Osteoarthritis of the Thumb Basal Joint. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.10.018

[12] Hand Surgery Patient Perspectives on Medical Cannabis: A Survey of Over 600 Patients. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.02.009

[13] Cannabis Use Following Total Joint Arthroplasty is Associated With Increased Risks? A Meta-Analysis. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.07.008

[14] A Synthetic Form of Cannabinoid Does Not Decrease Opioid Use After Total Knee Arthroplasty: A Prospective, Randomized, Triple-Blind, Placebo-Controlled Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.02.047

[15] CORR Insights®: Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003265

[16] The Effect of Marijuana on Postoperative Spine Patients' Emergency Department Visits, Readmission Rates, and Opioid Consumption. JAAOS: Global Research and Reviews. 2024. DOI: 10.5435/jaaosglobal-d-23-00206

[17] Knowledge and Opinion on Cannabinoids Among Orthopaedic Traumatologists. JAAOS: Global Research and Reviews. 2021. DOI: 10.5435/jaaosglobal-d-21-00047

[18] Effects Of Cannabidiol On Post-Operative Pain Following Arthroscopic Rotator Cuff Repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.032

[19] Cannabis Use Does Not Affect Outcomes After Total Hip Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.03.040

[20] Do Medical and Recreational Marijuana State Laws Impact Trends in Postoperative Opioid Prescriptions Among Patients Who Have Undergone TJA?. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003422

[21] Perceptions of Patient and Surgeon Marijuana Use: A Survey Study of Upper-Extremity Patients. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2024.11.010

[22] Cannabis and nicotine use are independently associated with adverse surgical, medical, and psychosocial outcomes following upper extremity fracture fixation. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-025-06635-w

[23] Medical Cannabis in Hand Surgery: A Review of the Current Evidence. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.11.008

[24] Poster 189. Cannabis Use in Patients Undergoing Sports Medicine Procedures and Post-Operative Pain Scores. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00487

[25] No Evidence That Preoperative Marijuana Use Influences the Success of Hip Arthroscopy for Femoracetabular Impingement in Adolescents and Young Adults. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251385152

[26] Effect of Marijuana Use on Pain Management and Return to Sport After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients: A Matched Control Study. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251369015

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