Cannabis in Acute Injury Rehabilitation: Analgesic Efficacy, Functional Outcomes and Dependency Risks
DOI:
https://doi.org/10.12775/QS.2025.41.60152Keywords
Cannabis, THC, CBD, Acute injury, Rehabilitation, Analgesia, AddictionAbstract
Background: Musculoskeletal injury rehabilitation is challenged by inadequate pain management using opioids and NSAIDs, which pose risks of addiction, side effects, and delayed healing. Cannabis has emerged as a potential analgesic, yet its efficacy, safety, and impact on functional recovery in acute injuries remain unclear, particularly for athletes.
Purpose of Research: To evaluate the role of cannabis in acute injury rehabilitation, focusing on analgesic efficacy, functional outcomes, addiction risks, and implications for athletic recovery.
Materials and Methods: A systematic review of PubMed and Google Scholar (2015–present) identified 24 studies (RCTs, observational studies, meta-analyses) assessing cannabis in acute injury rehab. Inclusion criteria prioritized pain scores (VAS/NRS), functional metrics (mobility, strength), and dependency rates (CUDIT). Non-English articles and animal studies were excluded.
Basic Results: Cannabis demonstrated moderate analgesic efficacy, with 30% pain reduction vs. placebo in acute musculoskeletal injuries. Low-dose THC matched opioid efficacy with fewer side effects, while CBD showed anti-inflammatory effects (22% IL-6 reduction). Functional improvements in mobility and therapy adherence were noted, but psychoactive effects (sedation, cognitive impairment) and a 10–15% cannabis use disorder (CUD) prevalence were reported. Discrepancies emerged between subjective pain relief and objective biomarkers.
Conclusions: Cannabis may offer short-term analgesic and functional benefits in acute injury rehab but requires careful risk-benefit assessment due to addiction potential, cognitive side effects, and variable dosing responses. Standardized guidelines, athlete-specific protocols, and multidisciplinary monitoring are critical to optimize therapeutic outcomes. Future research should prioritize long-term safety, dosing standardization, and sport-specific functional impacts.
References
1. You DZ, Leighton JL, Schneider PS. Current Concepts in Rehabilitation Protocols to Optimize Patient Function Following Musculoskeletal Trauma. Injury. 2020 May;51 Suppl 2:S5-S9. doi: 10.1016/j.injury.2020.03.047.
2. Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. J Comp Eff Res. 2022 Feb;11(2):121-129. doi: 10.2217/cer-2021-0258.
3. Hill KP, Palastro MD, Johnson B, Ditre JW. Cannabis and Pain: A Clinical Review. Cannabis Cannabinoid Res. 2017 May 1;2(1):96-104. doi: 10.1089/can.2017.0017.
4. Ebbert Ebbert JO, Scharf EL, Hurt RT. Medical Cannabis. Mayo Clin Proc. 2018 Dec;93(12):1842-1847. doi: 10.1016/j.mayocp.2018.09.005.
5. Häuser W, Petzke F, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management - An overview of systematic reviews. Eur J Pain. 2018 Mar;22(3):455-470. doi: 10.1002/ejp.1118.
6. Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018 Mar 7;3(3):CD012182. doi: 10.1002/14651858.CD012182.pub2.
7. Nugent SM, Morasco BJ, O'Neil ME, Freeman M, Low A, Kondo K, et. al. The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review. Ann Intern Med. 2017 Sep 5;167(5):319-331. doi: 10.7326/M17-0155.
8. Ware MA, Jensen D, Barrette A, Vernec A, Derman W. Cannabis and the Health and Performance of the Elite Athlete. Clin J Sport Med. 2018 Sep;28(5):480-484. doi: 10.1097/JSM.0000000000000650.
9. Schneider-Smith E, Salottolo K, Swartwood C, Melvin C, Madayag RM, Bar-Or D. Matched pilot study examining cannabis-based dronabinol for acute pain following traumatic injury. Trauma Surg Acute Care Open. 2020 Feb 9;5(1):e000391. doi: 10.1136/tsaco-2019-000391.
10. Gazendam A, Nucci N, Gouveia K, Abdel Khalik H, Rubinger L, Johal H. Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis. Cannabis Cannabinoid Res. 2020 Dec 15;5(4):290-297. doi: 10.1089/can.2019.0079.
11. Chan S, Wolt A, Zhang L, Lam H, Slaven M, Shaw E, et. al. Medical cannabis use for patients with post-traumatic stress disorder (PTSD). Journal of Pain Management. 2017 Feb 45:102345.
12. Furrer D, Kröger E, Marcotte M, Jauvin N, Bélanger R, Ware M, et. al. Cannabis against chronic musculoskeletal pain: a scoping review on users and their perceptions. J Cannabis Res. 2021 Sep 4;3(1):41. doi: 10.1186/s42238-021-00096-8.
13. Boehnke KF, Scott JR, Litinas E, Sisley S, Clauw DJ, Goesling J, et. al.. Cannabis Use Preferences and Decision-making Among a Cross-sectional Cohort of Medical Cannabis Patients with Chronic Pain. J Pain. 2019 Nov;20(11):1362-1372. doi: 10.1016/j.jpain.2019.05.009.
14. Millar SA, Stone NL, Bellman ZD, Yates AS, England TJ, O'Sullivan SE. A systematic review of cannabidiol dosing in clinical populations. Br J Clin Pharmacol. 2019 Sep;85(9):1888-1900. doi: 10.1111/bcp.14038.
15. Lee MC, Ploner M, Wiech K, Bingel U, Wanigasekera V, Brooks J, et.al. Amygdala activity contributes to the dissociative effect of cannabis on pain perception. Pain. 2015 Jan;154(1):124-134. doi: 10.1016/j.pain.2012.09.017.
16. Khodadadi H, Salles ÉL, Jarrahi A, Chibane F, Costigliola V, Yu JC, et. al. Cannabidiol Modulates Cytokine Storm in Acute Respiratory Distress Syndrome Induced by Simulated Viral Infection Using Synthetic RNA. Cannabis Cannabinoid Res. 2020 Sep 2;5(3):197-201. doi: 10.1089/can.2020.0043.
17. Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse. 2015 Jan;40(1):23-30. doi: 10.3109/00952990.2013.821477.
18. Hasin DS, Shmulewitz D, Sarvet AL. Time trends in US cannabis use and cannabis use disorders overall and by sociodemographic subgroups: a narrative review and new findings. Am J Drug Alcohol Abuse. 2019;45(6):623-643. doi: 10.1080/00952990.2019.1569668.
19. Campbell G, Hall WD, Peacock A, Lintzeris N, Bruno R, Larance B, et.al. Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study. Lancet Public Health. 2018 Jul;3(7):e341-e350. doi: 10.1016/S2468-2667(18)30110-5.
20. Volkow ND, Han B, Compton WM, McCance-Katz EF. Self-reported Medical and Nonmedical Cannabis Use Among Pregnant Women in the United States. JAMA. 2019 Jul 9;322(2):167-169. doi: 10.1001/jama.2019.7982.
21. Baron EP, Lucas P, Eades J, Hogue O. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. J Headache Pain. 2018 May 24;19(1):37. doi: 10.1186/s10194-018-0862-2.
22. Babson KA, Sottile J, Morabito D. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr Psychiatry Rep. 2017 Apr;19(4):23. doi: 10.1007/s11920-017-0775-9.
23. Volkow ND, Swanson JM, Evins AE, DeLisi LE, Meier MH, Gonzalez R, et. al. Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry. 2016 Mar;73(3):292-7. doi: 10.1001/jamapsychiatry.2015.3278.
24. Hillard CJ. The Endocannabinoid Signaling System in the CNS: A Primer. Int Rev Neurobiol. 2015;125:1-47. doi: 10.1016/bs.irn.2015.10.001. Epub 2015 Nov 6.
25. Russo EB. Cannabis Therapeutics and the Future of Neurology. Front Integr Neurosci. 2018 Oct 18;12:51. doi: 10.3389/fnint.2018.00051. PMID: 30405366;
26. Cooper ZD, Abrams DI, Gust S, Salicrup A, Throckmorton DC. Challenges for Clinical Cannabis and Cannabinoid Research in the United States. J Natl Cancer Inst Monogr. 2021 Nov 28;2021(58):114-122. doi: 10.1093/jncimonographs/lgab009.
27. Hasin DS. US Epidemiology of Cannabis Use and Associated Problems. Neuropsychopharmacology. 2018 Jan;43(1):195-212. doi: 10.1038/npp.2017.198. Epub 2017 Aug 30.
28. Stockings E, Campbell G, Hall WD, Nielsen S, Zagic D, Rahman R, et. al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018 Oct;159(10):1932-1954. doi: 10.1097/j.pain.0000000000001293.
29. Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M. The increasing global health priority of substance use in young people. Lancet Psychiatry. 2016 Mar;3(3):251-64. doi: 10.1016/S2215-0366(15)00508-8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Sebastian Polok, Justyna Talaska, Małgorzata Wasilewska, Krzysztof Pietrzak, Karol Demel
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 63
Number of citations: 0
