Have you ever wondered if CBD oil can really help with pain? Well, there’s a new urology study that investigated whether CBD oil can help in treating post-operative pain. I’m Dr. Rena Malik, a urologist and pelvic surgeon, and today I’m going to talk about that. Can CBD oil really help with your pain? Cannabidiol, or CBD oil, is a pain reliever that doesn’t cause dependency and has been shown to help some people with chronic and cancer-related pain. It’s made from hemp ants called cannabis sativa, which is different from tetrahydrocannabinol, or THC, the part of marijuana that gets you high. CBD oil is specifically approved by the Food and Drug Administration as an oral solution, and Epidiolex is one such approved product. It’s primarily used for the treatment of seizures and has shown anti-inflammatory and analgesic effects.
Our research group wanted to analyze the effects of this FDA-approved CBD oil for post-operative pain from a surgery we often do, called ureteroscopy. Ureteroscopy is done for people who have kidney stones in the kidney or in the ureter on the way to the bladder. It involves using a very small camera to go up the tube that drains the kidney, where you can use laser or a basket to remove the stone. Often, patients need a stent afterwards, a small plastic tube that goes from the kidney to the bladder to allow the area to heal and to prevent blockage during the healing process. Unfortunately, many people feel significant discomfort after the stent placement. I usually tell patients that a third of people don’t feel any pain, another third will feel the stent but won’t be too bothered by it, and a third will be very uncomfortable, experiencing symptoms like urgency, frequency, kidney spasms, flank pain, and general discomfort. Often, people need narcotics for this type of pain. In an era where many are becoming addicted to narcotics, we’re looking for alternative pain relief options, especially for such surgeries.
Interestingly, cannabinoid receptors are found in the bladder, kidneys, testicles, prostate, and vas deferens. Studies in animal models that modulate or stimulate these receptors have shown that the bladder’s smooth muscle responds to it. Activation of the endocannabinoid system has shown efficacy in treating chronic pelvic pain, chronic prostatitis, and even bladder dysfunction in patients with multiple sclerosis in some small studies. Thus, the anti-inflammatory properties of CBD oil and its potential to relax or control the smooth muscle in the bladder and potentially elsewhere in the lower urinary tract make it an attractive option for pain related to atrophy.
In this study, a prospective, double-blind, randomized, placebo-controlled trial was conducted. A group of patients was split half to receive CBD oil and half to receive a placebo. Both the patients and the doctors were blinded to who received which treatment. This type of study is considered the gold standard when analyzing any intervention to see if it works better than a placebo or a fake oil. The power of the placebo effect can be extremely powerful, as just thinking you’re taking something that will relieve your pain can significantly influence your brain and actual pain perception.
In the study, 90 patients were divided, with half receiving the placebo and the other half receiving 20 milligrams of CBD oil. The goal was to observe post-operative pain, the amount of opioids used, and any side effects. All patients were given CBD oil or placebo for three days post-surgery, to be taken as needed. Along with this, they also received twelve tablets of narcotic painkillers as rescue medication, to be taken every 6 hours as needed. When observing post-operative pain, there was no significant difference in maximum or average pain between the CBD and placebo groups during the post-operative period. Adherence was generally very good in both groups, with over 90% of people taking the CBD oil or the placebo. There was a slightly less use of narcotic medications in the group that received CBD oil, but this was not statistically significant. This means that the difference in the numbers could have been due to chance and not necessarily significant. There was no real difference in using it on the day of surgery or even after the surgery on days 1, 2, and 3. When asked on the third day after surgery about their feelings towards having a stent placed in the future, more people in the CBD group had mixed feelings or really didn’t want to have it compared to those who received the placebo. The only other difference observed was that on the first post-operative day, people in the CBD group experienced more dizziness than those in the placebo group – about 28% in the CBD group versus nearly 3% in the placebo group.
In summary, CBD oil did not significantly reduce pain scores, opioid use, or related symptoms, but it was safe and, apart from a bit of dizziness, well tolerated.