Cannabinoids for Acute Pain Management: A Contemporary Scoping Review of Evidence, Mechanisms, and Clinical Implications

Curr Pharm Des. 2026 Oct 5. doi: 10.2174/0113816128510427260927100857. Online ahead of print.

ABSTRACT

BACKGROUND: The global opioid crisis has intensified interest in non-opioid and opioid-sparing analgesic strategies, including cannabinoids. Despite the expanding legal landscape for cannabis and a rapidly growing cannabinoid market, the clinical evidence for cannabinoid use in acute pain management remains inconsistent and largely of low quality.

METHODS: This contemporary scoping review was conducted and reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). A systematic search of six electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, ClinicalKey, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and BIOSIS) was performed for literature published between 1 January 2016 and 5 April 2026, with the final database search executed on 5 April 2026, addressing the pharmacology, mechanisms of action, clinical efficacy, safety, and perioperative implications of cannabinoids in acute and postoperative pain. Two blinded reviewers independently screened records and charted data against predefined eligibility criteria; discrepancies were resolved by a third author. Findings are summarized narratively and in tabular format, and the study selection process is depicted in a PRISMA flow diagram.

RESULTS: Preclinical evidence supports robust antinociceptive effects of cannabinoids through multiple receptor pathways; however, these findings have not translated reliably into human acute pain models. Metaanalytic data demonstrate either no significant reduction in acute pain scores with cannabinoids versus placebo, or only small, clinically uncertain improvements. The opioid-sparing effect, while promising in preclinical and some chronic pain studies, has not been demonstrated for acute postoperative pain. A notable exception is a 2024 randomized trial showing a 40% reduction in opioid requirements with perioperative dronabinol after cardiac surgery. Safety data indicate that non-serious adverse events (dizziness, nausea, sedation) are consistently more frequent with cannabinoids than placebo. The 2023 American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus guidelines now formalize 21 recommendations for perioperative cannabinoid management.

CONCLUSION: While the biological rationale for cannabinoid analgesia is compelling, the clinical evidence base for acute pain remains insufficient to support routine use. Cannabinoids may serve as adjuncts in specific populations, but require careful patient selection, dose titration, and safety monitoring. Well-designed, large randomized controlled trials targeting defined acute pain populations are urgently needed.

PMID:42864800 | DOI:10.2174/0113816128510427260927100857