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Pain Management during Hospital Stay

Hi everyone,
I am brand new to this forum and I need some advice. I have been in PM for about 3 years and am prescribed Opana - it works for me, until I am admitted into the hospital. I have lymphedema in my left arm. For the past 5 years, I will get an infection that causes me to get celluitis (pretty severe). I usually pack a few things and go straight to the ER. I am always admitted because they hook me up to Vancomycin - which can only be run every 12 hours, so I usually stay for 3 days. My question for someone who has had a similar experience of being treated in hospital and trying to get effective pain management?
This infection happens around 2X a year. I have had the unfortunate experience of having to use my chronic pain meds to manage my hospital pain. At the hospital, my pain is not being treated properly (long story - blood pressure drops below <85). Anyway, this last incident just occurred right before Thanksgiving and I am seeing my Pain Man. Doc next week. I am short on my meds because I used them in the hospital. Does anyone here have experience with needing more than your usual chronic pain meds because you suffer an acute incident and need more than your usual dosage while in and after your hospital stay??
I would love to hear others stories or experiences. I am always honest with my Doc and I am going to share with him my trouble with this issue.
Thanks for reading.



  • LizLiz Posts: 7,832
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  • sandisandi Posts: 6,343
    edited 12/17/2013 - 8:23 AM
    even if you used them during your hospitalization? Most hospitals, while patients are being treated, want you to bring your meds to show them, but patients are not allowed to take their own medications while being treated in the hospital because of the liability issues/concerns and the potential for accidental overdosage.
    While the hospital may not have given you Opana, they would have converted the dosage of Opana to another medication carried by the pharmacy for the duration of your hospital stay.
    Since it was only a three day stay, and Opana is dosed every 12 hours, you shouldn't be 'short' of medications.
    There is a difference in treating acute pain episodes and your use of opiates for the treatment of Chronic pain, and the medications given to you for your chronic pain should not be taken to manage acute pain espisodes, the hospital was responsible for that need, if the doctors felt that you needed it.
    If, while in the hospital, your pain is not being managed effectively, then you always have the option of asking for a consult with the pain management department.
  • i have been to the hospital for cellilitus also, 3 times and the last was last month where i was given iv antibiotics, x-rays, cat scans, mri's and on and on. I also immediately told them that i was under the care of a pain dr and i gave them his name and phone number. they gave me narcotic pain meds for 4 days and as far as i know, they did not contact my pain dr. i was given meds in house and even with back surgeries, gall stones, i was given meds in the hospital and did not have to use mine at all. i have never heard of a person having to use their own pain meds when they were in the hospital. as part of the treatment, the hospital would work with my pain doctor as far as what to give, how and how much. they always worked in conjunction with each other. like sandi said due to liability issues, i believe it is illegal for a hospital to force a patient to use his own narcotic pain meds. always tell hospital the name etc of your pain dr and make sure they work together. this is a weird story and like i said, i have never heard of a hospital force a patient to use their own pain meds.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • dilaurodilauro ConnecticutPosts: 9,836
    edited 12/18/2013 - 6:09 AM
    patients to bring in any of their own medications. This is for you benefit as well as the people that are treating you.
    If for example, you are taking you own pain medications and then they give you what has be prescribed by the hospital that would falsify any future examinations while you are in the hospital.

    I've had a 4 surgeries the past two years, each time, there was an agreement between the surgeon, my pain management doctor and myself. 1 - Upon entering the hospital, I no longer take ANY of my medications 2 - My surgeon takes control of pain medications until I am formally discharged completely and 3 - My pain management doctor takes over then

    This way there is no reason for any shortage of any medication.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • i don't know policies on pain meds specifically, but i do know a hospital will allow you to bring your own meds, if its a medication their pharmacy doesn't carry. my last 2 surgeries, i was given a script for Emend to bring with me prior to surgery. (its a seriously strong anti-nausea med.) the hospital i used didn't stock it, because it was an orthopedic hospital and this is a chemotherapy drug.

    second instance.... i take zantac... hospital gives me prevacid because that is what they stock. took it during the 1st stay, and it doesn't work for me. I told the pharmacy this when preparing for my 2nd stay, and i had the option of bringing my own, or they did tell me they do stock a small amount for patients like me that the other med doesn't work on. so in the end, i didn't need to bring it myself, but they would have let me do it.

    so long story short, they do allow you to bring your own in certain cases i guess.
    Microdisectomy / hemi-laminectomy 6/2010 and revision 10/2010
    Cervical fusion C4-5 and C5-6 9/2011
    Lumbar Fusion L5-S1 6/2012
  • terror8396tterror8396 Posts: 1,832
    edited 12/18/2013 - 9:40 AM
    any med i had to have the hospital give to me wether it be narcotic, cholesterol, blood pressure, antacid anything they wrote it down and put it into the computer then they gave it to me from their pharmacy. if they did not carry it, i don't know. but from my experience, most hospital pharmacies carry most meds. i believe there are legalities letting a patient use their own meds. i am surprised that the hospital let you use them. in fact my pain dr warned me against bringing pain meds to hospital. it can be dangerous, taking your meds then the hospital's meds especially if narcotics. i'm sure their will be posters that say they could use their own meds, but i doubt it
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • TarenTTaren Posts: 525
    edited 12/18/2013 - 9:48 AM
    Same here I was allowed to bring in Creon, its a digestive enzyme that I have to have for chronic pancreatitis. I was also allowed to bring in Prilosec because the pharmacy only had IV protonix, they did not carry IV Prilosec--the protonix they provided worked so I did not need to bring the Prilosec in but yes I had to have my Creon brought in......However, I would never think a hospital would allow you to use your own pain medication if they were providing you with pain medication--that could cause an overdose....Did they know you were taking your own pain meds in addition to them giving you pain meds?? If you answered this question already then I apologize for asking again.....Anyway, I hope you are feeling better now. From reading some of Jon's posts about cellulitis I understand it is very painful and can cause alot of additional problems. Anyway, take care and welcome to Spine Health :-)
  • 1ofmanyinpain11ofmanyinpain Posts: 60
    edited 12/19/2013 - 11:37 AM
    I hate to say it but not all "things related to pain management are equal".. I understand that most of you think that we are all treated the same way when it comes to anything pain related... NOT TRUE... just because you have had good experiences doesn't mean we all have. I can see how some Hospitals don't follow your pain medications ritual and they do their own.. sometimes they don't do the conversions correctly and you can be way undermedicated... This was the case when I had my first back surgery... I had to take my own methadone with me and take it...even though the surgeon and my PM Dr. talked.. it doesn't always work out... in a Perfect World it might... but not in our World...
  • I don't believe that anyone said that all things are equal in pain management, but the hospitals will NOT allow a patient to take their own medications because of the liability issue. If they do not carry your particular medication/dosage , then they will convert it to what they do carry in their pharmacy.
    The use of other non opiates, they might in fact, allow the use of those, since they aren't in their formulary/supplies, but they are not scheduled medications/opiates.
    The hospital in your situation should have sent for a pain management consult to convert you to whatever the hospital had in stock , and as the patient, you always have the right to insist on a consult with another doctor if you feel that they are not treating or addressing your medical concerns appropriately.
  • terror8396tterror8396 Posts: 1,832
    edited 12/20/2013 - 6:34 AM
    it is amazing that the backlash regarding narcotics and any subject posted is argued. once again, hospitals will not let patients bring their own narcotics to use. these are schedule 2 drugs and are monitored extensively. the dea would not allow this to happen. i don't know why people keep arguing this point. it does not happen and if a hospital did allow it then they would be subjected to major disciplinary issues and the doctors and hospitals would lose their licenses. in an age where pain drs are paranoid about scrutiny from the dea a hospital would have it worse. not only would the hospital be liable, the head of the hospital, the nurses and all involved would lose their licenses. there always seem to be some that will argue and issue when the moderators and others say it would not happen.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I had to spend the day in the hospital after a myleogram. I was in excruciating pain and the nurse asked me if I had any narcotics with me! The best she could offer me was Tylenol. Needless to say, I couldn't wait to get home to take something!
    Lumbar laminectomy L-4/L-5, 2006
    XLIF with posterior pedicle screws L-4/L-5, 4-23-2013
  • thoracic spine painthoracic spine pain Posts: 566
    edited 12/22/2013 - 11:30 AM
    In Australia you are allowed to use your own meds, they don't like it, but my partner was on warfarin for years and plotted his dosage everyday so knew how much he needed to keep it stable. It is a long acting medication so you do not see the results until about 3 days after the dosage.

    He had to sign a form saying he was self medicating with his warfarin - he wasn't having an operation so they were not putting him on heparin. he only had started to take pain meds - the morphine that our GP gave him for pain really effected his breathing and I was scared he would stop breathing so took him back to our GP and who directed me to take him to the ER. He was sent home but then the Dr called me at 6 in the morning and said he had been thinking about it all night and wanted him to be admitted to hospital - thank heavens - I was up all night for three days monitoring him - so the hospital gave him pain meds and monitored them really well. If you want to self medicate here you have to sign a form that states the hospital is not responsible if anything happens. They don't like self medication - I don't blame them so if I was in hospital I would let them deal with my pain meds.

    But it your choice here as long as you sign a form negating the hospital from responsibility. Really don't know why you would chose to take your own pain meds if the hospital can give them to you, they usually monitor your pain meds really well.
  • Can I ask those who have had cellulitis when should you be hospitalized? I have had outbreaks since April. Mine goes into a 2 week cycle where I get a high fever, the redness and horrible pain. Then by the third or fourth day it slowly starts to get better. Sometimes the skin where it had been red hot red will peel. Then I get like 2 days where I feel so good I think it's gone and then bam, I get it again. My primary has done about 5 sets of antibiotics. They then got worried about inflammatory breast cancer so sent me to a breast surgeon who said no it wasn't breast cancer and put me on a 21 day regimen of stronger antibiotics. Within 4 days of stopping it, the cellulitis was back. Now I am going to be seeing an infectious doc on Dec. 31st. Because of lost records and errors it took a month for them to get me an appointment. I've been told my both my primary and family to go to the ER if it's to bad so I was wondering what to bad is. Can those of you with experience give me some input?

    As far as pain meds when admitted, they usually admit me with what I am currently on, and then add a pain med. It's usually the PCA with Dilaudid in it. I have chronic kidney stones so I am in a lot with those. The hospital has always supplied my meds, even the ones I am regularly on .I know one time they did not have the strength I was on so they gave me 2 of the lower strengths to make up for it.

    Hope you can get this resolved!

  • Terror I do not mean to argue, but you are allowed to bring in your own narcotics if the hospital does not have your kind or strength BUT you MUST turn all of it in to the nurse who then documents it and gives it to you as directed. Then at discharge, they give you back what is remaining. I would never do this because I have heard of too many stories where the hospital lost your meds so you don't get anything back. The best bet is to have your doc and PM consult together to make sure your pain is being managed.
  • if you have cellilitus, go to the hospital and get admitted asap. oral antibiotics do not cut it. only iv meds seemed to work. they can also do other tests to see if it is from your bones or whatever. i was in for 4 days with iv antibiotics and narcotics. they drew a line around my infection to see if it would grow. if it did, then possible amputation of the leg. it is very serious. it is a staph infection and needs to be taken care of. every time i had it i went to my dr to get me admitted to the hospital. i have had it twice in 2 years.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • My husband recently had it so bad it took over his whole left leg. He had the high fever and the whole nine yards. He was on oral antibiotics and did just fine. The hospital didn't even admit him, they just kept him long enough for his fever to go down. He has had it twice on his leg. Oral antibiotics worked great both times.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.
  • After re-reading the original post again, my understanding is that she used her own pain meds without the hospitals permission based on they wouldn't give her any due to low blood pressure. Basically regardless of being in the hospital or not, that is still considered self-medicating. When you are in the hospital the hospital is solely responsible for you and they would NOT allow narcotic meds to be self administered, no way. With the lawsuits these days, there is absolutely NO WAY, they will let that happen. They may allow it for other meds, but not for narcotics.

    I had an issue similar recently. I was in the hospital for a reason unrelated to my pain, but laying in the ICU for a week caused a LOT of pain. one nurse was very hesitant to give me anything because my BP was low (it was before they realized that my BP is chronically low) and I ended up lying in that bed for 15 hours with no relief what-so-ever and of course they couldn't figure out why i had a hard time moving after that. So i talked to the day nurse that morning and told her to get me the paperwork, I was signing out AMA because there was no way I could handle that anymore and I would continue my treatment at home rather than in the ICU (yea I know it sounded silly, but it really was that bad) and she spoke with the doctor and got it taken care of. Regardless, i wouldn't have even considered taking my own meds. You never know what it may be contradicted with, with the meds they give you to get you better. Doing something like that can kill you and leave the hospital liable.

    So basically to answer your question, the only thing you can do is tell your pain doctor what you did and hopefully he won't dismiss you as a patient for doing it. I would also advise to never do it again and get things prearranged for next time.
  • terror8396tterror8396 Posts: 1,832
    edited 12/24/2013 - 4:38 AM
    by the way the comment about not having your strength is not true. i have my oxy compounded and the strength i use is 45 mg and for 300 micrograms in the lollipops. hospitals do not use these strengths. so they gave me 4o mg of oxy and 250 micograms of the lollipops. they did not ask me to use my own. so this is not true. most hospitals have the required strenghts of narcotics. they have all types and strengths in their inventories. they told me they did not have these strengths of narcotics due to them not compounding the meds so they told me they were giving me the regular strengths. most hospitals carry every med and strengths available in their pharmacies. this is their business and their business is also to treat patients with appropriate meds and dosages. and i am sure if there is a med or dose not available they would contact another pharmacy or get permission from an appropriate doctor. like was stated before, lawsuit, lawsuit, lawsuit. hospitals, drrs and pharmacies are under a microscope now a days and they would not do anything to get them in trouble, narcotic or not.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Again, not to argue, but hospitals sometimes do not have the strength or med or the med you are on. I too am on the pops and one hospital didn't have my strength so they added 2 together and then a different hospital does not keep them in stock. So it can happen.
  • yes i had the same with my lollipops but my pain dr had to give the ok. they called him. they just did not give it to me at a different dose. apparently the issue of liability is not an issue. if hospitals gave a dose that is not around without permission from the patient's dr then there would be a law suit
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • hospitals will NOT allow a patient to take their own meds. That's the bottom line. If they do not stock the particular pain medication you are taking , they will convert you to what they do carry and once the orders are written by a staff physician, give you those medications during your hospitalization.
    If they only have a lesser strength dose of your medication, again they will either give you enough of the lower strength to give you the same dosage or convert you to another medication during your stay.
    The OP took her own medications without the consent of the hospital or knowledge of the hospital because she felt that they were not giving her pain medications due to her medical condition already being unstable, so they didn't give the amount of medications she felt she was entitled to so she took her own medications, which was not only dangerous and could have seriously compromised her already unstable condition, but could have caused her death and a huge liability to the hospital involved. She not only took her regular doses but more, because she felt that the hospital was inadequately addressing her pain, so now she is going to run out early. The OP has not reposted to this thread, that I am aware of since her first post.
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