Highlight
- Nearly 40% of patients undergoing elective sports medicine procedures reported prior CBD use, mainly for pain or sleep issues.
- About one-third of those using CBD perceived it as moderately or very helpful.
- Findings point to significant patient-driven demand for non-opioid pain and sleep management strategies in perioperative care.
- Current evidence for CBD’s efficacy remains limited, emphasizing the need for higher-quality studies and open clinician-patient dialogue.
Background
Pain and sleep disturbances are common challenges for patients undergoing elective orthopedic procedures, such as knee, hip, or shoulder surgery. Traditionally, multimodal analgesia—including opioids—has been the mainstay of perioperative pain control. However, rising concerns about opioid-related adverse effects, misuse, and dependence have intensified the search for safer alternatives. Cannabidiol (CBD), a non-psychoactive constituent of Cannabis sativa, has gained popularity as an over-the-counter remedy for pain and sleep concerns despite limited clinical trial evidence. This context sets the stage for understanding patient behaviors and unmet needs in perioperative pain and sleep management.
Study Overview and Methodological Design
Sideris and colleagues conducted a cross-sectional survey study (Madjarova S, et al. e-Poster 6529, Regional Anesthesiology and Acute Pain Medicine Meeting, May 2025) among 144 adult patients scheduled for elective sports medicine procedures involving the knee, hip, or shoulder at a single institution. The study period spanned from September 20, 2024, to December 23, 2024.
Key elements of the study design included:
- Population: Adults undergoing elective sports medicine procedures
- Recruitment: Preoperative clinic visits
- Data collection: Anonymous surveys querying prior and current CBD use, reasons for use (pain, sleep, etc.), administration route, procurement source, and perceived efficacy (Likert scale)
- Endpoints: Prevalence of CBD use, patient-reported efficacy, patterns of administration, and sources of information about CBD
This methodology captures a snapshot of real-world patient self-medication practices but is limited by its observational and self-reported nature.
Key Findings
Among the 144 respondents:
- 90% had heard of CBD, mostly through friends or media.
- 39% reported ever using CBD; 36% of these had used it within a year of surgery.
- The most common reason for use was pain management, followed by sleep improvement.
- Oral administration (gummies) was preferred by 62%, while 48% used topical forms (lotions or balms).
- Most patients obtained CBD from dispensaries.
- On the Likert scale, about one-third of users found CBD moderately or very helpful for their symptoms.
The study did not include a formal control group or objective measures of efficacy, so findings reflect patient perceptions rather than clinical outcomes.
Mechanistic Insights and Pathophysiological Context
CBD is believed to exert analgesic and anxiolytic effects through modulation of the endocannabinoid system, which regulates pain, mood, and sleep. Preclinical studies suggest CBD may reduce inflammation, modulate nociceptive signaling, and influence sleep architecture via interactions with CB1 and CB2 receptors as well as non-cannabinoid targets (e.g., serotonin receptors). However, in humans, robust clinical evidence supporting these mechanisms—particularly in acute postoperative settings—remains sparse [1].
Clinical Implications
The widespread self-medication with CBD among surgical patients reflects both unmet needs and evolving patient preferences. For clinicians, these findings highlight the importance of proactively discussing non-prescription supplement use during preoperative consultations.
While patient-driven interest in CBD may offer an opportunity to reduce reliance on opioids, clinicians remain hampered by the lack of high-quality, reproducible clinical trials demonstrating CBD’s safety and efficacy for perioperative pain or sleep disturbances [2]. Therefore, current guidelines do not formally endorse CBD as part of multimodal analgesia regimens. Nevertheless, open, nonjudgmental dialogue can foster shared decision-making, identify potential drug interactions (e.g., with anesthetics or anticoagulants), and ensure patient safety.
Limitations and Controversies
Several limitations warrant caution:
- Survey-based data may be subject to recall bias, reporting bias, and selection bias.
- No objective pain or sleep outcomes were measured, nor was there a comparator group.
- CBD products are highly variable in composition, dosing, and purity; most are not FDA-regulated.
- The placebo effect is well-documented in pain management studies and may partially explain perceived benefits.
- Existing literature remains inconclusive, with systematic reviews citing heterogeneity and methodological flaws in CBD research [3].
Expert Commentary or Guideline Positioning
Dr. Alexandra Sideris, director of the Pain Prevention Research Center at Hospital for Special Surgery, emphasizes the need for clinicians to inquire about CBD and cannabis use without judgment, fostering a more comprehensive perioperative assessment.
According to recent guidelines from the American Society of Anesthesiologists and the American Academy of Orthopaedic Surgeons, there is insufficient evidence to recommend CBD for acute postoperative pain or sleep disturbances. Both organizations advocate for further well-controlled studies and individualized patient counseling [4,5].
Conclusion
The notable prevalence of CBD use for pain and sleep among elective orthopedic surgery patients underscores both a significant unmet need and an emerging trend in self-directed care. While roughly one-third of users perceived moderate benefit, the clinical evidence remains inconclusive. Until higher-quality data are available, clinicians should approach the topic proactively, balancing patient interest with safety considerations and evidence-based practice. Expanded research—including randomized controlled trials and pharmacovigilance studies—will be essential to define the role of CBD as a potential opioid alternative in perioperative care.
References
1. Häuser W, Fitzcharles M-A, Radbruch L, Petzke F. Cannabinoids in Pain Management and Palliative Medicine. Dtsch Arztebl Int. 2017;114(38):627-634.
2. Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol use for fibromyalgia: prevalence of use and perceptions of efficacy in a large online survey. J Pain. 2021;22(5):556-566.
3. Bhaskar A, Bell A, Boivin M, et al. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Pain Res. 2021;14:945-954.
4. American Society of Anesthesiologists. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report. Anesthesiology. 2022;136(2):161-179.
5. American Academy of Orthopaedic Surgeons. Management of Postoperative Pain Clinical Practice Guideline. 2023. Accessible at: https://www.aaos.org/guidelines/postoperativepain/.
