Perceptions in orthopedic surgery on the use of cannabis in treating pain: a survey of patients with spine pain (POSIT Spine)
Marko Gjorgjievski 1, Kim Madden 2 3, Conner Bullen 4, Frank Koziarz 2, Alex Koziarz 5, Aleksa Cenic 5 6, Silvia Li 2, Mohit Bhandari 3, Herman Johal 3
- 1Division of Orthopedic Surgery, Department of Surgery, Victory 3, Kingston General Hospital, Queen’s University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. markogjorgjievski@gmail.com.
- 2Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- 3Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- 4Faculty of Pharmacy, University of Toronto, Toronto, Canada.
- 5Department of Radiology, McMaster University, Hamilton, ON, Canada.
- 6Division of Neurosurgery, Department of Surgery, McMaster, University, Hamilton, Canada.
Affiliationer
Background: Back pain is the leading cause of disability worldwide. Despite guidelines discouraging opioids as first-line treatment, opioids remain the most prescribed drugs for back pain. There is renewed interest in exploring the potential medical applications of cannabis, and with the recent changes in national legislation there is a unique opportunity to investigate the analgesic properties of cannabis.
Methods: This was a multi-center survey-based study examining patient perceptions regarding cannabis for spine pain. We included patients presenting with back or neck pain to one of three Orthopedic clinics in Ontario. Our primary outcome was perceived effect of cannabis on back pain, while secondary outcomes were perceptions regarding potential applications and barriers to cannabis use.
Results: 259 patients participated in this study, 35.3% (90/255) stating they used cannabis medically. Average pain severity was 6.5/10 ± 0.3 (95% CI 6.2-6.8). Nearly three-quarters were prescribed opioids (73.6%, 148/201), with oxycodone/oxycontin (45.9% 68/148) being the most common, and almost half of (49.3%, 73/148) had used an opioid in the last week. Patients estimated cannabis could treat 54.3% ± 4.0 (95% CI 50.3-58.3%) of their spine pain and replace 46.2% ± 6. 6 (95% CI 39.6-52.8%) of their current analgesics. Age (β = – 0.3, CI – 0.6-0.0), higher pain severity (β = 0.4, CI 0.1-0.6) and previous cannabis use (β = 14.7, CI 5.1-24.4) were associated with a higher perceived effect of cannabis. Patients thought cannabis would be beneficial to treat pain (129/146, 88.4%), and reduce (116/146, 79.5%) or eliminate opioids (102/146, 69.9%). Not considering using cannabis for medical purposes (65/150, 43.3%) was the number one reported barrier.
Conclusions: Patients estimated medical cannabis could treat more than half of their spine pain, with one in three patients already using medical cannabis. 79% of patients also believe cannabis could reduce opioid usage. This data will help support more research into cannabis for musculoskeletal pain.
Keywords: Back pain; Cannabis; MSK pain; Opioid alternative; Opioid epidemic; Opioids; Orthopedics; Patient perceptions; Spine pain; Survey.
