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  • Author
    Alexis Cheney
  • PI

    Alexandra Stavrakis, MD

  • Co-Author

    Elizabeth Lord, MD and Alexandra Stavrakis, MD

  • Title

    Prevalence and Perceived Analgesic Utility of Cannabinoid Use for Pain in Musculoskeletal Joint Clinic Patients

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  • Abstract

    Background: Cannabis policy is rapidly evolving with public opinion and legislation favoring increased legalization of medicinal and recreational marijuana in the United States and globally. This has sparked increased interest in its use among orthopaedic patients by either prescription or self-medication despite limited evidence regarding the efficacy, safety, and adverse effects of cannabinoid preparations in this patient population. To date, the majority of musculoskeletal-relevant cannabis literature focuses on treatment of conditions such as multiple sclerosis, fibromyalgia, and spinal cord injury. Few studies have evaluated the benefits and risks of cannabinoid use for treatment of neuropathic, post-operative, and arthritis-related pain specifically. Additionally, as of present there are no cannabis containing, cannabis-derived, or cannabidiol compounds approved by the FDA for use in patients with musculoskeletal disorders. This lack of FDA oversight allows for wide variability in the composition, quality, and effectiveness of cannabinoid preparations used by patients for recreational or medicinal purposes. This poses a concern to public health, and with the use of cannabinoid products on the rise further research is needed to help establish the safety and efficacy of these products.

    Purpose: The aim of this study is to assess patient behaviors, perceptions, and quality of life measures as they relate to cannabis use for the treatment of joint-specific pain in musculoskeletal (MSK) clinic patients. This is undertaken with the goal of bridging the knowledge gap so as to help inform patients and providers of potential risks and benefits of cannabinoid use as well as guide future recommendations for its use.

    Methods: We conducted a cross-sectional study of all consecutive patients aged 18 years or older presenting to the UCLA Orthopaedic Surgery subspeciality joint clinics for treatment of joint-related musculoskeletal pain. An online questionnaire to be completed on a patient’s own personal device was administered to all eligible patients via REDCap for an enrollment period of 4.5 months. Exclusion criteria for the study included patients under the age of 18 years or those unable to complete the online questionnaire. The questionnaire asked patients questions about their current or past cannabis usage including frequency, dosage, and method of consumption as well as perceptions regarding cannabis, experienced side effects following cannabis use, the reason for which they are seeing their doctor, and pain levels. Patients were also asked to answer questions regarding demographics as well as use, frequency, and pain relief from other medications and adjuvant therapies. All data was collected via REDCap. Excel was used to calculate PROMIS score averages and confidence intervals. One-way ANOVA was used to evaluate PROMIS scores for statistical significance in differences between groups across the three measures evaluated: pain behavior, pain interference, and physical function.

    Results: Of the 1,542 patients invited to complete the online questionnaire, 46 patients completed the survey, yielding a response rate of 2.98%. In this cohort, 60.9% were female and 39.1% were male. The average age was 70.09 years. Among survey respondents, 48% indicated that they currently utilize cannabis for recreational or medicinal purposes and 15% of patients indicated using these products daily or more. Only 52% of patients have never or are not currently using cannabinoid products. Additionally, findings indicated that the majority of patients, both cannabis users and non-users, believe cannabinoid products to have possible analgesic, anti-inflammatory, and anti-anxiolytic effects, among others. Despite this belief, no statistical significance in differences in Pain Reported Outcome Measurement Information System (PROMIS) scores between cannabis users and non-users was found across all three health measures evaluated.

    Conclusion: Our findings suggest that a significant percentage of orthopaedic patients utilize cannabinoid products for both recreational and medicinal purposes, with perceived beneficial medicinal effects including relief of joint-related musculoskeletal pain. The prevalence of cannabis use within this sub-population of MSK patients is significantly higher than recent estimates of past-year marijuana use for U.S. adults. The high prevalence of cannabis use among orthopaedic joint clinic patients reinforces the need to establish the safety, efficacy, and adverse effects of these products. Further analysis of the data will expand upon the work already performed and will take into consideration the likelihood of a cannabis dose-dependent or product type-dependent effect. Logistic regression will also be used to adjust for possible confounding factors.

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