Poster 373: Perceptions & Opinions on Cannabidiol Among Sports Medicine Orthopaedic Surgeons

Abstract

Objectives: Cannabidiol (CBD) is a known pain modulator which is beginning to garner increased attention in the orthopaedic world, with many patients now presenting to clinics having tried CBD for pain relief. However, there may be a considerable knowledge gap with particular reference to orthopedic sports medicine surgeons and how they perceive the use of this therapeutic agent in clinical practice. The purpose of this study is to (1) examine the knowledge and beliefs of sports medicine orthopaedic surgeons with respect to the role of cannabidiol (CBD) in a multi-modal post-operative pain management regimen (2) deliver an educational component regarding CBD to practicing surgeons, and to (3) elucidate potential future barriers to the widespread use of this treatment modality by providing an anonymous forum for surgeons to voice their opinions. Methods: A three-component, 25-question online survey was distributed to fellowship-trained sports medicine orthopaedic surgeons. The first 20 questions were designed to assess baseline knowledge and opinions of sports surgeons regarding cannabidiol. These were followed by a 1-page summary sheet detailing the current legal status of CBD, as well as a brief literature review of its potential role in pain management within the field of orthopaedics. Lastly, 5 additional questions assessed whether the respondents’ opinions had shifted after learning more about CBD. A Visual Analog Scale (VAS) was used for one question (“Please indicate the likelihood you would recommend CBD as part of a pain management regimen.”), which was repeated before and after the summary sheet to see if respondents modified their answer after completing the educational component. Results: One hundred responses were collected from sports medicine surgeons. Most surgeons (76.2%) believe there is a role for CBD in post-operative pain management. While only 62.4% of respondents believe that CBD could be effective in managing acute pain and inflammation following injury, an overwhelming majority (94.1%) believed that CBD has a role in chronic pain management. A large majority stated that CBD would have no effect on soft tissue (89.1%) or bony (90.1%) healing post- operatively. Most surgeons admitted they were not knowledgeable about the mechanism (84.2%), modes of administration (73.3%), or their states’ laws (66.3%) concerning CBD. A minority (24.8%) believe that CBD has psychoactive properties and 18.8% believe CBD has addictive potential. While most surgeons (76.2%) did not believe they would be stigmatized if they were to suggest CBD to a patient, only 47.5% have ever suggested CBD to a patient. Notably, 94.1% of surgeons have encountered patients who reported trying CBD to treat pain. In the optional open-response section, 32 respondents elaborated on their concerns with most sentiments falling into three predominant themes: a) more evidence is required (10, 31.3%); b) stigmatization from patients (8, 25.0%); c) more regulation is required (5, 15.6%). After reading through the fact sheet, 51.4% of the survey respondents stated that their opinion on CBD had changed, and 62.9% stated they felt inclined to investigate the topic further on their own. Conclusions: A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management. Surgeons are somewhat familiar with CBD, in part due to its remarkable prevalence among their patient populations, however there is clearly a knowledge gap, suggesting more education is necessary involving what is currently known about the subject and that more research should be targeted toward this developing industry. Current barriers to its routine use in clinical practice include unfamiliarity of the mechanism and dosing, limited evidence and regulation, and patient concerns or patient/surgeon stigmatization.