Dr. Frankel's Journal


October 5, 2018
Allan Frankel, MD

In recent months, a number of patients have come in to see me regarding which cannabinoid profile might be effective in the post-operative period. Of course, their reasoning for the consultation is in anticipation of minimizing post-operative pain.

Unfortunately, patients often come in following their surgery when they are in a considerable amount of pain and are using narcotics. Previously, I hadn’t considered encouraging patients to come in prior to their surgeries, but in hindsight, I realize that it makes a lot of sense and has proven to be extremely helpful for them. When a patient comes in to see me a few weeks preceding their surgery, we are able to determine their THC tolerance and anticipate which extracts or topical products are helpful for them. When the patient is ready for surgery, they have by then tried a few formulations that have helped manage their existing pain and were well tolerated. The treatment plan that was developed before surgery to treat the existing pain should then help treat the post- operative pain as well.

As THC is often required as a component of the pain management regimen, determining the patient’s THC tolerance pre-operatively is crucial. It not only helps them acclimate to the THC effect over a few weeks, it gives them options in their post-operative period as well. Although some patients are able to use the medicine while still hospitalized, some will be required to wait until they are recovering at home. Regardless, the patient now has options to treat their pain. The sooner the cannabis is started post-operatively, the sooner the benefit. Often, this allows for much lower doses of narcotics.

During that pre-operative period, the patient is most likely going to use CBD with minimal THC at the start and slowly increase the amount of THC. In a three week period, most patients are able to go from mostly whole plant CBD extract to a THC:CBD 1:1 extract, or even a “THC only” extract in low doses of 3-5 mg every 4-6 hours. Even if there is some psychoactivity, there would be considerably less than narcotics. Additionally, any risk of addiction would be significantly reduced.

To my recollection, there have been two patients who did so well using cannabis in the treatment of their pain that they were able to postpone their surgery. Most narcotic abuse starts innocently, and often begins post-operatively.  Pain combined with anxiety and/or depression from months or years of discomfort, can predispose the patient to prolonged narcotic use. By minimizing the use of narcotics, and by providing a healthier alternative for not only pain management, but also anxiety/depression, it is reasonable to believe that we should see a significant drop in narcotic addiction in the post-operative patient.