The prescription of medical cannabis by a transitional pain service to wean a patient with complex pain from opioid use following liver transplantation: a case report.
OBJECTIVE
The purpose of this case report is to describe a patient with a preoperative complex pain syndrome who underwent liver transplantation and was able to reduce his opioid consumption significantly following the initiation of treatment with medical cannabis.


METHODS
A 57-yr-old male with a history of hepatitis C cirrhosis underwent liver transplantation. Preoperatively, he was taking hydromorphone 2-8 mg⋅day(-1) for chronic abdominal pain. Postoperatively, he was given intravenous patient-controlled analgesia through which he received hydromorphone 30 mg⋅day(-1). Our multidisciplinary Transitional Pain Service was involved with managing his moderate to severe acute postsurgical pain in hospital and continued with weaning him from opioid medications after discharge. It was difficult to wean the patient from opioids, and he was subsequently given medical cannabis at six weeks postoperatively with remarkable effect. By the fifth postoperative month, his use of opioids had tapered to 6 mg⋅day(-1) of hydromorphone, and his functional status was excellent on this regimen.


CONCLUSIONS
Reductions in opioid consumption were achieved with the administration of medical cannabis in a patient with acute postoperative pain superimposed on a chronic pain syndrome and receiving high doses of opioids. Concurrent benefits of initiating medical cannabis may include improvements in pain profile and functional status along with reductions in opioid-related side effects. This highlights the potential for medical cannabis as an adjunct medication for weaning patients from opioid use.
Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
Howard
H
Meng
Department of Anesthesia, University of Toronto, Toronto, ON, Canada.|Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada.
John G
JG
Hanlon
Department of Anesthesia, University of Toronto, Toronto, ON, Canada.|Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3 EB 317, Toronto, ON, M5G 2C4, Canada.|Transtional Pain Service, Toronto General Hospital, Toronto, ON, Canada.
Rita
R
Katznelson
Division of General Surgery, University Health Network, Toronto, ON, Canada.
Anand
A
Ghanekar
Division of General Surgery, University Health Network, Toronto, ON, Canada.
Ian
I
McGilvray
Department of Anesthesia, University of Toronto, Toronto, ON, Canada. hance.clarke@utoronto.ca.|Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3 EB 317, Toronto, ON, M5G 2C4, Canada. hance.clarke@utoronto.ca.|Transtional Pain Service, Toronto General Hospital, Toronto, ON, Canada. hance.clarke@utoronto.ca.
Hance
H
Clarke
D015746:Abdominal Pain / Q000188:drug therapy*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D006526:Hepatitis C / Q000150:complications / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D064086:Medical Marijuana / Q000627:therapeutic use*; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*
D000701:Analgesics, Opioid; D064086:Medical Marijuana