{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:03:10Z","timestamp":1777384990693,"version":"3.51.4"},"reference-count":11,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hospice patients with advanced degenerative spine disease frequently experience refractory neuropathic pain complicated by opioid tolerance, central sensitization, and functional decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 63-year-old male with stage III adhesive arachnoiditis, cauda equina syndrome, prior spinal cord stimulator implantation, and multiple lumbar surgeries was admitted to hospice with uncontrolled multifactorial back pain. Due to refractory pain that could not be adequately managed in the outpatient setting, the patient was enrolled in home hospice care. Methadone rotation, pregabalin, corticosteroids, and escalating hydromorphone dosing provided limited relief. Oral ketamine was introduced for opioid-refractory pain and titrated from 10\u00a0mg 3 times daily to 40\u00a0mg 4 times daily with gradual improvement in pain severity, sleep, and functional activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multimodal hospice care incorporating opioid optimization, adjuvant medications, and NMDA antagonists such as ketamine may improve quality of life in advanced degenerative spinal disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261447440","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T13:20:15Z","timestamp":1776864015000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Refractory Neuropathic Pain With Escalating Opioid Requirements and Ketamine Use in Advanced Degenerative Spine Disease: A Hospice Case Report"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1811-7413","authenticated-orcid":false,"given":"Gokhan","family":"Demir","sequence":"first","affiliation":[{"name":"HCA Florida Aventura Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sneha","family":"Akurati","sequence":"additional","affiliation":[{"name":"University of Miami Leonard M. Miller School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel Sanchez","family":"Artiles","sequence":"additional","affiliation":[{"name":"HCA Florida Aventura Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malika","family":"Rahaman","sequence":"additional","affiliation":[{"name":"Catholic Health Services"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy","family":"Romanello","sequence":"additional","affiliation":[{"name":"HCA Florida Aventura Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"e_1_3_4_2_2","first-page":"2447","article-title":"Opioid analgesic therapy in advanced cancer","volume":"382","author":"Mercadante S","year":"2020","unstructured":"Mercadante S, Bruera E. Opioid analgesic therapy in advanced cancer. 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