CBD oil does not reduce pain in patients after ureteroscopy

Cannabidiol (CBD) oil was found to have no advantage over placebo in reducing pain following ureteroscopy (URS) and stent placement for patients with urinary stones, according to findings presented in The Journal of Urology.¹

On postoperative day 3, average pain score for the CBD cohort was 2.5, compared with the placebo cohort which had an average pain score of 2.6.

"In our experience, many patients ask whether CBD could be an effective option for managing pain after URS with stent placement. Our study provides high-quality evidence to counsel patients in this situation: While CBD oil appears safe, it does not seem to reduce pain or discomfort during the typically brief recovery period after this common procedure,” said senior author Karen Stern, MD, in a news release on the findings.² Stern is a urologist at Mayo Clinic in Phoenix, Arizona.

The prospective study included 90 patients who were undergoing ureteroscopy and stent placement for urinary stones. The average age of patients included in the study was 64. Participants were randomized 1:1 to placebo (n=45) or 20 mg cannabidiol oil (n=45) daily for 3 days postoperatively. Patients in both groups were prescribed the standard medications of tamsulosin, oxybutynin, and phenazopyridine as well as a rescue narcotic to use if needed for severe pain.

Both groups had similar operative time, number of stones treated, cumulative stone diameter, and stent size utilization. Average maximum pain score on the day of surgery was 2.2 for both groups, measured using a standard visual analog scale.

After surgery, data showed that there was no significant difference in post-operative pain scores between both groups. Both cohorts observed a reduction in average pain scores from postoperative day 1 to postoperative day 3. On postoperative day 3, average pain score for the CBD cohort was 2.5, compared with the placebo cohort which had an average pain score of 2.6 (P = 0.8). There was no difference in rescue narcotic usage between either group.

Further, there was no significant difference among pain scores associated with the ureteral stent between the groups. However, compared with the placebo group, more patients in the CBD group expressed mixed feelings or negative feelings toward having a stent placed in the future if required.

In regard to adverse events, significantly more patients in the CBD group noted experiencing dizziness on postoperative day 1 than the placebo group, but the difference was resolved by postoperative day 3. There were no other significant differences noted among the groups in regard to adverse events.

The authors concluded, “Postoperative CBD was safe but ineffective when compared to placebo in minimizing post-URS stent discomfort or opioid usage. Despite the availability of numerous analgesic agents, stent-related symptoms and bother continue to be a factor in patient care.”

References

1. Narang G, Moore J, Wymer K, et al. Effect of cannabidiol oil on post-ureteroscopy pain for urinary calculi: A randomized, double-blind, placebo-controlled trial. J Urol. 2023;209(4):726-733. doi: 10.1097/JU.0000000000003139.

2. CBD oil doesn’t reduce pain after common treatment for urinary stones. News release. Wolters Kluwer Health: Lippincott. Published online March 9, 2023. Accessed March 22, 2023. https://www.newswise.com/articles/cbd-oil-doesn-t-reduce-pain-after-common-treatment-for-urinary-stones