Non-traditional treatments offer ‘remarkable’ results for Omaha metro patients with chronic pain, depression
Published: Aug. 14, 2025 at 10:38 PM CDT
OMAHA, Neb. (WOWT) – A Fremont mother says a medication, traditionally used as a general anesthetic, has dramatically improved her chronic pain and mental health.
Elanor Koch’s life unraveled when doctors found a tumor on her cervical spine in 2020. “It had eroded away and condensed my spinal cord over 60%,” said Koch.
Following neck fusion surgery, she was left with neuropathy, myelopathy and had to relearn some motor skills, such as walking and using her left arm.
After all of that, Koch said she still had debilitating pain, with flares that would make it hard for her to get out of bed for days at a time.
“It’s exhausting and a very defeating feeling, like you already wake up tired. You’re not sleeping because of pain, you’re not participating in your children’s lives, or giving 100% to your job, no matter how many hours you put in,” explained Koch.
Elanor Koch, of Fremont, is a mother of two young children.(Elanor Koch)
She struggled to manage her pain in a way she felt was safe and effective. “Opioid pain therapy didn’t feel like a good long-term solution. Other alternative pain management areas were not working,” said Koch.
Koch also deals with anxiety and other mental health hurdles, which worsened during this period.
In 2023, her best friend, Lexi, learned about IV ketamine infusion therapy and suggested Koch give it a try.
IV ketamine infusions
Koch connected with Tim Brady, a Nurse Anesthesiologist and the Owner of Mind and Body Wellness Center in Omaha.
“Elanor’s case is not unusual for chronic pain clients to also have depression. Ketamine, when used properly, is a great way to break up the negative feedback loop of pain and depression,” Brady wrote in a statement to First Alert 6.
The off-label treatment is said to help people with depression, PTSD, anxiety, and chronic pain.
During the IV ketamine infusion sessions, which last about an hour, patients experience dissociation.(First Alert 6)
Rob Snarskis is a coach and journey guide at Mind and Body Wellness. He said ketamine interacts with receptors in the brain, leading to an increase in neuroplasticity. Put simply, it can help people process thoughts and emotions more effectively.
“There’s what’s called a default mode network. It’s an area in the brain which kind of houses the sense of self, or ego, or identity, or belief systems. What the ketamine is doing is kind of just relaxing so that you have a little bit more access to outside of what you believe is yourself,” said Snarskis.
“When I’ve went through ketamine, I had a perspective that I’d never been able to force myself into. To see it for what it is and understand that that’s part of the experience of why we’re here, and it didn’t feel like my pain was as daunting,” said Koch.
During the sessions, which last about an hour, patients experience dissociation.
“You’re not fully aware of your physical body and you’re kind of just hanging out in your head for a while, but it’s also a lot of internal visuals and processing of emotions. Sometimes I’m just relaxed the entire time and yesterday I had a lot to work through, and I cried a lot, and that’s what I needed,” explained Koch.
“People kind of need that surrender to go deeper into it and kind of disassociate from their identity, their body, their patterns, the things that are making them stuck as they’re coming in here,” said Snarskis.
A transformed life
After six initial treatments in one month, Koch said she was pain-free for three months and noticed significant improvements in her energy and mood. “I had minor flares every once in a while, but they weren’t long-lasting and they weren’t common or close together,” said Koch.
Koch felt well enough to pursue one of her dreams, becoming a tattoo artist. “I have a lot more inspiration and my brain has a lot less stress in it,” said Koch.
It’s something she previously wouldn’t have been able to handle with her physical ailments. “I’m not in the back of my head begging to be able to lie down. I have the full stamina to be able to give the full attention to each piece that I do,” she said.
Elanor Koch tattoos a client.(First Alert 6)
She also said it’s helped her become a more present mother again for her two young children. “We get to do a lot more fun things together, and they see that. They get to feel like, ‘Oh my gosh, this day is so awesome.’ They get a lot more of those,” shared Koch.
However, affording maintenance infusions after the initial treatments proved a challenge for Koch.
Infusions at Mind and Body Wellness cost $400-500 per session and are not covered by insurance, since ketamine is not FDA-approved for these treatments.
Esketamine for depression
Dr. Stephen Salzbrenner, a Psychiatrist at Nebraska Medicine, said affordability is often a barrier to access for ketamine infusions.
“It’s pretty widely accepted in the scientific community that it’s effective, and so it’s offered. If it was FDA approved for depression, insurance might cover it as a treatment, but since it’s not, it’s done out of pocket a lot of times,” said Salzbrenner.
For the last few years, Salzbrenner has offered an alternative treatment for depression that is FDA-approved and is typically accepted by insurance.
Salzbrenner runs the esketamine program at Nebraska Medicine. Esketamine, which is sold under the brand name Spravato, is a nasal spray medication.
“I’ve got some people that they’ve tried every antidepressant they can think of, they’re like 40 years old, and an hour after getting their first dose of esketamine they say, ‘I feel normal for the first time in my life that I can remember,’ and they never want to stop,” said Salzbrenner.
Esketamine, which is sold under the brand name of Spravato, is a nasal spray medication. (Dr. Stephen Salzbrenner)
Esketamine is chemically related to ketamine but has a distinct chemical makeup.
Salzbrenner said patients usually notice a difference in their mood the same day they receive a dose. “It can happen within hours. It’s really pretty remarkable, because a lot of the traditional antidepressants take 6 – 8 weeks before we really know if it’s going to help,” explained Salzbrenner.
While the treatment is self-administered, it must be done in-clinic. Salzbrenner said after the initial month of treatment, most people come in once a week for a maintenance dose. After it’s administered, the patient must remain at the clinic for two hours of mandatory observation.
“That’s what’s called a REMS program, it’s Risk Evaluation Mitigation Strategy. Some really high-risk medications have these programs in place to really encourage and verify that it’s being used responsibly and that we’re monitoring it appropriately,” said Salzbrenner.
Salzbrenner said the risk of developing dependence is low, as long as it’s only used as prescribed. That’s part of the reason patients must receive their doses in-clinic.
Salzbrenner also said some patients experience a short period of dissociation during the observation period.
“It doesn’t happen all the time, and it’s not linked to effectiveness, so if it doesn’t happen, that doesn’t mean it isn’t working. It’s kind of like this feeling that you’re not connected to yourself or your surroundings. You’re just not continuous with what’s around you. A lot of people actually kind of like it, they feel like it’s a break from their own thoughts and their own distress. They just have 20 minutes of peace,” said Salzbrenner.
He would like to offer IV ketamine infusions at Nebraska Medicine eventually as well, but said, “it takes a lot of people cooperating, because anesthesia has to be involved, you have to have a setting where it’s safe to give it, and the outpatient psychiatric clinic is probably not equipped for that right now. But, it is effective, and I would recommend anyone who has the financial means, especially if they failed esketamine.”
Salzbrennder adds, it’s essential to couple esketamine treatment with talk therapy. “Therapy is really indispensable. You can’t replicate that with a medicine.”
Continuing a journey of healing
It’s a sentiment Koch echoes. She has a psychiatrist and a talk therapist and said she no longer takes any antidepressant medications. “This is a really great tool and medicine, but it also comes with a lot of footwork outside of the room,” said Koch.
Financial donations from friends and family helped Koch restart treatments recently.
Not only had many of her pain symptoms returned after going without treatment for an extended period, but she was also grieving the sudden death of her best friend, Lexi.
Elanor Koch’s best friend, Lexi. (Elanor Koch)
After three rounds of infusions, Koch said she’s again noticed tremendous improvements both physically and mentally.
“Putting yourself in a position where you’re isolated with your thoughts and really allowing yourself to feel something is really hard, but I felt a lot better and a lot more at peace with those feelings,” she explained.
She’s now hoping to keep up with maintenance infusions every few months.
“It sounds intimidating, but it’s the best thing that I’ve ever done for myself, and if my word counts for anything as somebody who could barely get out of bed two years ago, I’d say try it,” said Koch.
Side effects and contraindicated candidates
There are possible side effects to be aware of during both treatments and people with certain medical histories who may not be good candidates.
Tim Brady, owner of Mind and Body Wellness Center, said people who may not be good candidates for IV ketamine infusions include those with an extreme mental health diagnosis, such as multiple personalities, schizophrenia, or manic bipolar. Also, people with uncontrolled high blood pressure, end organ failure, severe heart disease, and high-risk aneurysms.
Brady said some side effects of ketamine can be controlled with IV medicines when they arise during treatment. Those include increased heart rate and nausea or vomiting.
He said sometimes people cry during dissociation or have bodily shaking, which he says is “a release of energy that has been pent up inside and needs to come through.” Brady also said some people have anxiety during dissociation, but that “through consultation, proper preparation and having a “guide” in the room can alleviate anxiety greatly.”
Dr. Salzbrenner said people who may not be good candidates for esketamine include those with a significant history of substance use disorder, vascular disease, traumatic brain injuries, and difficulty with emotional control or tolerance of stress.
Salzbrenner said side effects of esketamine treatment include sedation, nausea, and headache. He said those symptoms typically resolve before the patient leaves the clinic following their two-hour monitoring period.
There is also a specific risk for those with a history of a hemorrhagic aneurysm.
“During esketamine treatment, there’s just a brief increase in blood pressure. So, if you’ve had a hemorrhagic aneurysm, it could like burst. You have to be very careful, maybe not even get the treatment, but I do have people that have had that, I just have neurosurgery consult to make sure that it’s safe,” explained Salzbrenner.
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