Taking CBD For Knee Replacement: Is It A Good Idea? | Yes And No, Here’s What To Consider

Written By on June 27, 2022 — Medically Reviewed By Mitch Torres (PT)

An increasingly popular and safe alternative to painkillers is CBD. For knee replacement, taking it before the surgery isn’t a good idea. But using it afterward can help provide pain relief.

With that said, you must consult with your doctor first before taking it, as it may interact with certain medications.

Now, we’ll discuss what CBD can do before and after knee replacement surgery. Also, some things to consider before taking it. Here’s a list of the topics covered, click any of them to navigate through the content:

CBD before knee replacement surgery

Taking cannabidiol (CBD) for knee pain can be extremely helpful, but it may be dangerous to consume it just before surgery. (1, 2)

This has to do with some side effects that may complicate the procedure. See, the two main issues that make CBD unsafe to use before surgery are:

1) Blood-thinning

One study found that CBD can make the blood thinner, which is something we don’t want during surgery. This is because it increases the risk of bleeding out. (3)

Any surgical procedure has a risk of blood loss. But when it comes to knee replacement surgery, this risk is multiplied. (4)

That, added to the blood-thinning effects of CBD, can seriously increase your risk of bleeding out during the procedure.

2) Interactions with anesthesia

CBD can affect how your anesthetic medications work.

You may need higher doses for them to provide the same effects. This increase can cause other non-surgical complications and can delay your recovery time. (5, 6, 7)

That’s why it’s best to avoid using CBD before any major surgery, like knee replacement. Instead, try other natural alternatives for pain management, like home remedies.

Pro tip: Openly discuss your pain relief options with your doctor, more so when the day of the surgery approaches.

CBD after knee replacement surgery

CBD may be beneficial to manage some post-surgical problems, such as (8, 9):

  • Post-surgical pain management.
  • Nausea.
  • Vomiting.
  • Difficulty sleeping.

This means that CBD can be a solid adjunctive treatment during the post-operative period.

Not only due to its pain-relieving, properties, but its lack of addiction potential. This is key, as it’s one of the most concerning problems of common pain medications. (10, 11)

The form of CBD is also extremely important. Topical (transdermal) cannabidiol reduces inflammation, according to studies. But, it may not be enough for patients recovering from a total knee replacement. (12)

For them, it may be best to try taking it orally or sublingually.

How does CBD work for pain relief?

The exact mechanism behind why it works isn’t fully understood. (13, 14)

From what’s known, CBD works by inhibiting the pain signal, as well as reducing inflammation. Researchers believe these effects happen because of how it interacts with the endocannabinoid system. (15)

The endocannabinoid system is a complex network involved in pain sensation.

It consists of various nerve cells and pathways that play a vital role in transmitting pain. This system also works with specific chemicals our body makes, known as endocannabinoids. (15, 16)

Now, CBD is chemically similar to our body’s endocannabinoids. That’s why it can interact with the endocannabinoid system. (16)

This interaction is believed to ultimately provide relief in joint diseases like rheumatoid arthritis and knee osteoarthritis. (17)

But, CBD doesn’t only relieve joint pain. It can also help in other conditions, such as (14):

Side effects of CBD vs other painkillers

There are several medications for knee pain available. And, although they are effective for pain, their side effects are a worrying aspect.

NSAIDs and opioids are common drugs used to relieve pain, but they can have the following side effects (11, 18, 19):

  • Stomach pain.
  • Gastric ulcers.
  • Nausea and vomiting.
  • Heartburn.
  • Diarrhea.
  • Constipation.
  • Urinary retention.
  • Impaired thinking skills.
  • Drowsiness.
  • Breathing problems.
  • Addiction.

CBD doesn’t have nearly as many side effects, though.

That’s why healthcare research is looking into it as a safer pain management option. However, like every other drug, it does have some side effects. The most common include (20, 21):

  • Nausea.
  • Fatigue, somnolence.
  • Diarrhea.
  • Drowsiness.

But some patients should refrain from taking it, as they may suffer other side effects.

So please, be cautious of using CBD if you are (21, 22):

  • Planning surgery soon.
  • Under any type of prescription medication.
  • Self-prescribing with over-the-counter drugs.
  • Under an antitubercular regimen. 
  • Have allergies to CBD or sesame oil.
  • Have a history of drug or alcohol addiction.
  • Have a history of mood disorders.

Dosage of CBD for knee replacement pain

As of now, there isn’t a recommended dose for CBD. Multiple studies have found varying amounts to be effective for different conditions. (21, 22

They all agree that the quantity depends on several factors, such as: 

  • Bodyweight.
  • Concentration.
  • Form.
  • The condition for which it’s being used.

For most people, finding the right dosage is a trial and error process. The safest practice is to start with low doses first and gradually increase them weekly.

Pros and cons of using CBD

Some of the pros of CBD include (19, 23, 24):

  • It’s safe for most people, with minimal side effects in healthy patients.
  • Can help manage pain in various conditions.
  • It’s safer than NSAIDs and opioids.
  • May help tackle addiction problems caused by opioids.

While some of the cons of CBD include (23, 25, 26):

  • More research is still needed to understand the role of CBD in knee replacement surgery.
  • It’s not properly regulated, meaning oral and topical CBD products may vary in quality and safety.
  • It has side effects that can be exacerbated in certain patients.
  • The FDA does not support CBD use for conditions other than epilepsy.
  • It shouldn’t be combined with other medications.

Make sure to consider all of this before deciding whether to take CBD or not.

FAQs

Is CBD oil good for knee replacement pain?

Yes, as long as your doctor approves. Just make sure to leave it under the tongue for a few minutes for faster effects.

Can you take CBD for pain after knee replacement?

Yes, but after discussing it with your doctor first to make sure it won’t interact negatively with other medications.

Conclusion: Is CBD beneficial for pain before and after knee replacement?

CBD can beneficial for the management of post-surgical knee pain. This is because of its pain-relieving and anti-inflammatory properties. 

But it’s not wise to take it before the procedure, due to the increased risk of adverse events.

With that said, taking this supplement won’t be the only way you recover from your surgery. Going to physical therapy, sleeping well, and following your doctor’s recommendations will provide more relief than taking one supplement.

Resources

  1. Yu, Jonathan S et al. “Rates of self-directed perioperative cannabidiol use in patients undergoing total hip or knee arthroplasty.” Pain management vol. 11,6 (2021): 655-660. doi:10.2217/pmt-2021-0018
  2. Runner, Robert P et al. “Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty.” The Journal of arthroplasty vol. 35,6S (2020): S138-S143. doi:10.1016/j.arth.2020.01.077
  3. Coetzee, C et al. “Anticoagulant effects of a Cannabis extract in an obese rat model.” Phytomedicine : international journal of phytotherapy and phytopharmacology vol. 14,5 (2007): 333-7. doi:10.1016/j.phymed.2006.02.004
  4. Boutsiadis, Achilleas et al. “Factors that influence blood loss and need for transfusion following total knee arthroplasty.” Annals of translational medicine vol. 5,21 (2017): 418. doi:10.21037/atm.2017.08.11
  5. Rong, Carola et al. “Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents.” Expert opinion on drug safety vol. 17,1 (2018): 51-54. doi:10.1080/14740338.2017.1397128
  6. “After Surgery: Discomforts and Complications.” Johns Hopkins Medicine, 8 Aug. 2021, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/after-surgery-discomforts-and-complications.
  7. Rock, E M et al. “Cannabidiol, a non-psychotropic component of cannabis, attenuates vomiting and nausea-like behaviour via indirect agonism of 5-HT(1A) somatodendritic autoreceptors in the dorsal raphe nucleus.” British journal of pharmacology vol. 165,8 (2012): 2620-34. doi:10.1111/j.1476-5381.2011.01621.x
  8. Parker, Linda A et al. “Regulation of nausea and vomiting by cannabinoids.” British journal of pharmacology vol. 163,7 (2011): 1411-22. doi:10.1111/j.1476-5381.2010.01176.x
  9. Russo, Ethan B. “Cannabinoids in the management of difficult to treat pain.” Therapeutics and clinical risk management vol. 4,1 (2008): 245-59. doi:10.2147/tcrm.s1928
  10. Babson, Kimberly A et al. “Cannabis, Cannabinoids, and Sleep: a Review of the Literature.”Current psychiatry reports vol. 19,4 (2017): 23. doi:10.1007/s11920-017-0775-9
  11. NIDA. “Overview.” National Institute on Drug Abuse, 21 Jan. 2022, https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/overview
  12. Haffar, Amer et al. “Topical Cannabidiol (CBD) After Total Knee Arthroplasty Does Not Decrease Pain or Opioid Use: A Prospective Randomized Double-Blinded Placebo-Controlled Trial.” The Journal of arthroplasty, S0883-5403(22)00383-7. 4 Apr. 2022, doi:10.1016/j.arth.2022.03.081
  13. Crocq, Marc-Antoine. “History of cannabis and the endocannabinoid system.” Dialogues in clinical neuroscience vol. 22,3 (2020): 223-228. doi:10.31887/DCNS.2020.22.3/mcrocq
  14. Bruni, Natascia, et al. “Cannabinoid delivery systems for pain and inflammation treatment.” Molecules 23.10 (2018): 2478.
  15. Mlost, Jakub, Marta Bryk, and Katarzyna Starowicz. “Cannabidiol for pain treatment: focus on pharmacology and mechanism of action.” International journal of molecular sciences 21.22 (2020): 8870.
  16. Kilaru, Aruna, and Kent D. Chapman. “The endocannabinoid system.” Essays in Biochemistry 64.3 (2020): 485-499.
  17. Darkovska-Serafimovska, Marija, et al. “Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases.” Journal of pain research 11 (2018): 837.
  18. “Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).” Cleveland Clinic, https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids
  19. Baldini, Angee et al. “A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide.” The primary care companion for CNS disorders vol. 14,3 (2012): PCC.11m01326. doi:10.4088/PCC.11m01326  
  20. Brown, Joshua D, and Almut G Winterstein. “Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use.” Journal of clinical medicine vol. 8,7 989. 8 Jul. 2019, doi:10.3390/jcm8070989
  21. Meissner H, Cascella M. Cannabidiol (CBD) [Updated 2022 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556048/
  22. Vivace, Bradley J et al. “Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies.” Journal of orthopaedic surgery and research vol. 16,1 57. 14 Jan. 2021, doi:10.1186/s13018-021-02205-y
  23. Iffland, Kerstin, and Franjo Grotenhermen. “An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies.” Cannabis and cannabinoid research vol. 2,1 139-154. 1 Jun. 2017, doi:10.1089/can.2016.0034
  24. Prud’homme, Mélissa et al. “Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence.” Substance abuse : research and treatment vol. 9 33-8. 21 May. 2015, doi:10.4137/SART.S25081
  25. Commissioner, Office of the. “FDA Notice Regarding CBD.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/news-events/press-announcements/fda-warns-companies-illegally-selling-over-counter-cbd-products-pain-relief
  26. Commissioner, Office of the. “FDA Regulation of Cannabis and Cannabis-Derived Products: Q&A.” https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd.

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Author
Sony Sherpa (MD)
Sony Sherpa is a board-certified clinical doctor and currently, she is working as a medical officer in the emergency department of a renowned hospital. With a medical degree completed at a young age, she writes medical articles with accuracy owing to her medical knowledge and thorough background research.

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