$450 a session: The cost of a pain treatment insurance often ignores

Chronic pain patients in Clark County and across the country are turning to ketamine infusion therapy because traditional pain management methods are failing them, but the treatment costs between $400 and $500 per session and is rarely covered by insurance.

The therapy involves an hour-long infusion that slows down pain-sensing nerves sending messages to the brain. For patients who have tried opioids or other alternatives without success, this off-label treatment is presented as a possible solution. Dr. Stephen Salzbrenner at Nebraska Medicine noted that while the scientific community widely accepts the treatment's effectiveness, insurance companies often do not cover it because it is not yet FDA-approved for depression, a common co-occurring condition.

Elanor Koch, a patient from Nebraska, described her experience with the therapy after doctors found a tumor on her cervical spine in 2020 that compressed her spinal cord by more than 60%. Even after neck fusion surgery and relearning to walk, Koch struggled with debilitating pain. She began ketamine infusions in 2023 at the Mind and Body Wellness Center.

Koch reported that after six treatments in one month, she was pain-free for three months. She described the sessions as a state of dissociation where she was not fully aware of her physical body. "I had minor flares every once in a while, but they weren't long lasting, and they weren't very common or close together," she said. She now requires maintenance infusions every few months.

For those who need a treatment that insurance will cover, Dr. Salzbrenner points to esketamine, a nasal spray that is chemically related to ketamine but has a distinct makeup. This FDA-approved alternative is accepted by insurance for depression. Salzbrenner said esketamine can show effects within hours, whereas traditional antidepressants often take six to eight weeks.

Both the infusion and the spray are most effective when combined with talk therapy. Salzbrenner called therapy indispensable, noting that medicine cannot replicate that aspect of care. Koch, who works with a psychiatrist and a talk therapist, said she is no longer taking antidepressant medications. "If my word counts for anything as somebody who could barely get out of bed two years ago, I'd say try it," she said.

Not every patient is a candidate for ketamine infusion. The treatment may not be suitable for people with schizophrenia, uncontrolled high blood pressure, heart disease, kidney or liver disease, or a substance use disorder.