Forthcoming

Effectiveness of Cannabis Oil as an Adjuvant Therapy in Patients with Severe Knee Osteoarthritis: A Randomized, Double-Blind Study

Authors

  • Warin Prucksikanont, MD Department of Orthopaedics, Srisangworn Hospital, Sukhothai, Thailand
  • Prangrugee Nakeim Dispensary Unit, Pharmacy Section, Srisangworn Hospital, Sukhothai, Thailand
  • Isanee Sitasut Orthopedic Clinic, Outpatient Department, Srisangworn Hospital, Sukhothai, Thailand
  • Thuchirapan Thianman Department of Thai Traditional Medicine, Division of Primary Care, Srisangworn Hospital, Sukhothai, Thailand

DOI:

https://doi.org/10.56929/jseaortho-2024-0223

Keywords:

cannabis, THC, CBD, knee osteoarthritis, KOOS, MCID

Abstract

Purpose: The removal of cannabis from Thailand's narcotic drug list presents both opportunities and challenges for medical use. The effectiveness of cannabis oil in treating severe knee osteoarthritis in patients awaiting total knee arthroplasty was evaluated in this study.

Methods: Thirty-two patients with severe knee osteoarthritis, unresponsive to conservative treatment, were enrolled and divided into two equal groups. The control and experimental groups received syrup and cannabis oil, respectively, at night for 30 days. Pain and quality of life (QOL) were assessed using the Numeric Rating Scale (NRS), and the Knee Injury and Osteoarthritis Outcome Score (KOOS), respectively. Liver and kidney functions were also assessed.

Results: The experimental group showed a significant reduction in NRS scores compared to the control group (p = 0.00015). Significant improvements were observed in KOOS subscales for pain, activities of daily living (ADL), and QOL (p = 0.01). However, the symptoms subscale improvement was not significant (p = 0.14). When comparing the KOOS subscales, no significant differences were observed between the groups (p > 0.05). Liver and kidney function remained stable in both groups. Despite these improvements, the changes did not reach a minimal clinically important difference (MCID), indicating limited clinical perceptibility to the patients.

Conclusions: Cannabis oil was associated with significant improvements in pain, ADL, and QOL in severe knee osteoarthritis. Although improvements did not meet MCID thresholds, observed benefits suggest potential for pain management. Larger controlled studies are recommended to confirm its clinical efficacy in pain management.

Metrics

Metrics Loading ...

References

National Health Security Office. Bang Pa-in Hospital: A model community hospital with knee replacement surgery capability [Internet]. Available from: https://www.nhso.go.th/news/ 4321. Accessed Jan 29, 2024.

Atalay S, Jarocka-Karpowicz I, Skrzydlewska E. Antioxidative and anti-inflammatory properties of cannabidiol. Antioxidants (Basel) 2019;9:21.

Martin EL, Strickland JC, Schlienz NJ, et al. Antidepressant and anxiolytic effects of medicinal cannabis use in an observational trial. Front Psychiatry 2021;12:729800.

Scopaz KA, Piva SR, Wisniewski S, et al. Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis. Arch Phys Med Rehabil 2009;90: 1866-73.

Lykins W. Efficacy of cannabidiol in treating osteoarthritis. J Orthop Physician Assist 2021;9: e21.00012.

Echeverria-Villalobos M, Todeschini AB, Stoicea N, et al. Perioperative care of cannabis users: A comprehensive review of pharmacological and anesthetic considerations. J Clin Anesth 2019;57: 41-9.

Holdcroft A, Maze M, Dore C, et al. A multicenter dose-escalation study of the analgesic and adverse effects of an oral cannabis extract (Cannador) for postoperative pain management. Anesthesiology 2006;104:1040-6.

Maharajan MK, Yong YJ, Yip HY, et al. Medical cannabis for chronic pain: Can it make a difference in pain management? J Anesth 2020; 34:95-103.

Lopez-Quintero C, Perez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 2011;115:120-30.

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 Cannabis Res 2021;3:22.

Chaipinyo K. Test-retest reliability and construct validity of Thai version of Knee Osteoarthritis Outcome Score (KOOS). Thai J Phys Ther 2009;31:67-76.

Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003;1:64.

Rosner B. Fundamentals of Biostatistics. 7th ed. Harvard University; 2010. p.228-34.

Lovecchio F, Langhans MT, Bennett T, et al. Prevalence of cannabidiol use in patients with spine complaints: Results of an anonymous survey. Int J Spine Surg 2021;15:663-8.

Yassin M, Oron A, Robinson D. Effect of adding medical cannabis to analgesic treatment in patients with low back pain related to fibromyalgia: An observational cross-over single centre study. Clin Exp Rheumatol 2019;37 Suppl 116:13-20.

Vakharia RM, Sodhi N, Anis HK, et al. Patients who have cannabis use disorder have higher rates of venous thromboemboli, readmission rates, and costs following primary total knee arthroplasty. J Arthroplasty 2020;35:997-1002.

Sinemyiz A, Jarocka-Karpowicz I, Skrzydlewska E. Antioxidative and anti-inflammatory properties of cannabidiol. Antioxidants (Basel) 2020;9:21.

Boehnke KF, Joel JG, Lynne M, et al. Cannabidiol use for fibromyalgia: Prevalence of use and perceptions of effectiveness in a large online survey. J Pain 2021;22:556-66.

Rodriguez-Merchan EC. Knee instruments and rating scales designed to measure outcomes. J Orthop Traumatol 2012;13:1-6.

Arkell TR, Kevin RC, Vinckenbosch F, et al. Sex differences in acute cannabis effects revisited: Results from two randomized, controlled trials. Addict Biol 2022;27:e13125.

Francis A, Erridge S, Holvey C, et al. Assessment of clinical outcomes in patients with osteoarthritis: Analysis from the UK medical cannabis registry. J Pain Palliat Care Pharmacother 2024;38:103-16.

Frane N, Stapleton E, Iturriaga C, et al. Cannabidiol as a treatment for arthritis and joint pain: An exploratory cross-sectional study. J Cannabis Res 2022;4:47.

Vannabouathong C, Zhu M, Chang Y, et al. Can medical cannabis therapies be cost-effective in the non-surgical management of chronic knee pain? Clin Med Insights Arthritis Musculoskelet Disord 2021;14:11795441211002492.

Suzuki H, Aono S, Inoue S, et al. Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain. PLoS One 2020;15: e0229228.

Eleswarapu AS, Divi SN, Dirschl DR, et al. How effective is physical therapy for common low back pain diagnoses? A multivariate analysis of 4597 patients. Spine (Phila Pa 1976) 2016;41: 1325-9.

Jacquet C, Pioger C, Khakha R, et al. Evaluation of the minimal clinically important difference (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2021;29:820-6.

Downloads

Published

2024-11-19

How to Cite

1.
Prucksikanont W, Nakeim P, Sitasut I, Thianman T. Effectiveness of Cannabis Oil as an Adjuvant Therapy in Patients with Severe Knee Osteoarthritis: A Randomized, Double-Blind Study. JseaOrtho [Internet]. 2024 Nov. 19 [cited 2024 Dec. 11];. Available from: https://www.jseaortho.org/index.php/jsao/article/view/223

Issue

Section

Original Articles

Similar Articles

You may also start an advanced similarity search for this article.