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JU INSIGHT Effect of Cannabidiol Oil on Post-ureteroscopy Pain for Urinary Calculi: A Randomized, Double-blind, Placebo-controlled Trial
By: Gopal Narang, MD, University of North Carolina, Chapel Hill; Jonathan Moore, MD, Dalhousie University, Halifax, Nova Scotia, Canada; Kevin Wymer, MD, Mayo Clinic Phoenix, Arizona; Yu-Hui Chang, PhD, MS, Mayo Clinic, Scottsdale, Arizona; Elisabeth Lim, MPH, Mayo Clinic Scottsdale, Arizona; Olufunmilola Adeleye, DO, MBA, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona; Mitchell R. Humphreys, MD, Mayo Clinic Phoenix, Arizona; Karen L. Stern, MD, Mayo Clinic, Phoenix, Arizona | Posted on: 20 Apr 2023
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.
Study Need and Importance
As advanced as the surgical management of stones has become, postoperative ureteral stent discomfort continues to pose a significant challenge to providers. Cannabinoid receptors are found throughout the urinary system, with lab studies showing modulation in bladder smooth muscle contractility when targeted. While activation of the cannabinoid system has shown efficacy in treating some lower urinary tract dysfunction and pain, there has not been any previous work on the effect of cannabinoids on ureteral stent discomfort. This study was a prospective, randomized, double-blind, placebo-controlled trial assessing the effect of a Food and Drug Administration–approved cannabidiol (CBD) oil (Epidiolex, Jazz Pharmaceuticals Inc) on post-ureteroscopy pain.
What We Found
Ninety patients in total were included in the final analysis. Overall, adherence to the medication in both groups was excellent with >90% of patients taking their allocated trial medication. There were no significant differences in maximum pain score on day 3 (primary outcome; see Figure) or any of the secondary outcomes including Ureteral Stent Symptoms Questionnaire, perioperative and rescue narcotic administration, study drug compliance, discharge medication usage, adverse drug reactions, and postoperative complications. There were no significant side effects of the CBD oil, and aside from a short period of postoperative dizziness, the medication was well tolerated.
Limitations
Limitations include that we utilized the lowest dose of CBD oil available to establish safety. In addition, our formulation did not contain tetrahydrocannabinol, which is known to have a stronger affinity to endocannabinoid receptors than CBD alone.
Interpretation for Patient Care
Despite this being a negative study in terms of intervention efficacy, it is the first of its kind. Further work evaluating the effect of CBD oil in the post-ureteroscopy setting would benefit from dose escalation and evaluating alternative analogs—such as those with a combination of CBD and tetrahydrocannabinol.
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