Yale School of Medicine (YSM) faculty William C. Becker, MD, associate professor (general internal medicine); Susan Crowley, MD, FASN, professor of medicine (nephrology); and Alicia Heapy, PhD; associate professor of psychiatry; teamed with Yale School of Public Health’s (YSPH) Denise Esserman, PhD, associate professor of biostatistics, were recently awarded a grant for their project, “Video-Telecare Collaborative Pain Management to Improve Function and Reduce Opioid Risk in Patients with End Stage Renal Disease Receiving Hemodialysis” through The Helping to End Addiction Long-term, or the NIH HEAL Initiative.
The National Institutes of Health launched the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative, in April 2018 to improve prevention and treatment strategies for opioid misuse and addiction and enhance pain management. The NIH HEAL Initiative aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose and achieve long-term recovery from opioid addiction.
“Patients with end-stage renal disease on hemodialysis have high rates of chronic pain and are especially susceptible to many of the harms associated with long-term opioid therapy. This award will allow us to test a combined behavioral/medication management strategy in helping this vulnerable population improve quality of life and function while decreasing opioid-related risk,” explained Becker.
Becker and Crowley are faculty within the Department of Internal Medicine at YSM and are based at the VA Connecticut Healthcare System (VACHS) facility in West Haven. Becker is a general internist with clinical epidemiology, addiction medicine, and pain management training, whose research, educational and clinical efforts broadly aim to improve the quality of chronic pain treatment in general medical settings, especially in the complex overlap of chronic pain and opioid use disorder. He directs the Opioid Reassessment Clinic at VACHS. Crowley serves as the Veterans Health Administration (VHA) National Program Director for Kidney Disease and Dialysis, and leads the development of clinical policies and programs in nephrology for VACHS. In addition, she is the chief of the Renal section at VACHS.
Heapy is faculty within YSM’s Department of Psychiatry and is also based at VACHS. She is a clinical psychologist with expertise in psychological interventions for chronic pain and the behavioral intervention she designed (COPES – Cooperative Pain Education and Self-management) and has successfully tested in other trials will be adapted to patients with ESRD and tested in this study. She is the Associate Director of the Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation at VACHS.
Patients with end-stage renal disease on hemodialysis have high rates of chronic pain and are especially susceptible to many of the harms associated with long-term opioid therapy. This award will allow us to test a combined behavioral/medication management strategy in helping this vulnerable population improve quality of life and function while decreasing opioid-related risk.
Dr. William Becker
Esserman’s methodology work focuses on the design of clinical trials. Her areas of research focus include: cluster randomized clinical trials with time-to-event outcomes and two-stage clinical trials that focus on patient preference. More recently, she has begun work on phase II single-arm oncology trials. For this award, Esserman was instrumental in the design of the trial using an innovative SMART (Sequential, multiple assignment, randomized trial) design. She wrote the sample size and analysis plan and helped to formulate the testable hypotheses.
Five faculty within the Department of Internal Medicine won awards as part of the NIH HEAL Initiative, which funded 75 grant awards across 41 states in fiscal year 2019 to apply scientific solutions to reverse the national opioid crisis. This grant falls under the “Integrated Approach to pain and Opioid Use in Hemodialysis Patients” research program within the NIH HEAL Initiative.
“It’s clear that a multi-pronged scientific approach is needed to reduce the risks of opioids, accelerate development of effective non-opioid therapies for pain and provide more flexible and effective options for treating addiction to opioids,” said NIH Director Francis S. Collins, MD, PhD, who launched the initiative in early 2018. “This unprecedented investment in the NIH HEAL Initiative demonstrates the commitment to reversing this devastating crisis.”
The Sections of General Internal Medicine and Nephrology are two of the eleven academic sections within YSM’s Department of Internal Medicine. To learn more about their work, visit General Internal Medicine or Nephrology.