Examining pain management for patients with chronic kidney disease

When patients with chronic kidney disease need long-term pain management, physicians face a difficult balancing act.

Isaiah Yim, a member of the Virginia Tech Carilion School of Medicine (VTCSOM) Class of 2026, studied what happens when those patients switch from long-term opioid use to long-term nonsteroidal anti-inflammatory drugs, or NSAIDs — medications widely used to treat pain but known to carry potential kidney risks.

“My research is on whether patients with chronic kidney disease who switch from long-term opioids to long-term NSAIDs experience worsened kidney function as a result of that switch,” Yim said.

The project, conducted with mentors John Epling, professor and vice chair of research and population health in the department of family and community medicine at VTCSOM, and Michelle Rockwell, director of health systems science and interprofessional practice, Phase 1, earned Yim a Letter of Distinction at the school’s annual Medical Student Research Symposium. 

“Isaiah came to our group with a strong interest in data science and took on a complex project examining whether efforts to reduce opioid prescribing might lead to unintended kidney harms from NSAIDs,” Epling said. “He worked through a very large and challenging dataset with persistence and focus. What made the project especially valuable was that the findings challenged our original hypothesis, which often leads to the most important insights in medicine.”

The study addresses a timely clinical question. In response to the national opioid crisis, there has been a strong push to reduce long-term opioid prescribing. But for patients with chronic kidney disease, alternatives are not always straightforward.

“There’s been a strong national effort to de-prescribe opioids because of many potential risks involved, like addiction, overdose and death,” Yim said. “The problem is there are not many other good options for pain management. Many patients are being put on NSAIDs as a result, but they are known to damage the kidneys.”

Using the TriNetX national database, which compiles health information from 61 health systems, Yim analyzed outcomes among patients with chronic kidney disease who switched from long-term opioids to long-term NSAIDs. He compared their kidney function, particularly glomerular filtration rate, or GFR, with patients who went from long-term opioids to long-term NSAIDs, long-term NSAIDs plus opioids, remained on long-term opioids, or switched to no pain medications.

“We found that the chronic kidney disease patients who switch to long-term NSAIDs did not experience worsened kidney function. Their kidney function was similar to those who stayed on long-term opioids or those who switched to no analgesics or no pain medications,” Yim said.

One finding stood out.

“We looked at patients who had chronic kidney disease in stages one, two and three,” he said. “It was surprising to us that, particularly for those in stage three with the most deficient kidney function, there wasn’t really any significant change on any pain medication.”

The results suggest that switching to NSAIDs may be safer for kidney function than some clinicians and patients might expect. Still, Yim emphasized that pain management decisions should remain individualized.

“I don’t think the solution is necessarily to just stop all opioids,” he said. “Ultimately, it’s up to each clinician and patient to manage their pain on an individualized basis. This study helps to understand the potential impacts on their kidney function so that they can have a more educated discussion.”

One limitation of the study was the inability to track over-the-counter NSAID use, which could affect results. Future research, Yim said, should further explore long-term NSAID use and kidney outcomes.

Conducting research during medical school has shaped how he approaches medicine.

“Research can help influence guidelines, and will ultimately affect outcomes for our patients,” Yim said. “In order to deliver the best care possible, we need to just keep striving to ask questions, conduct studies and be willing to change as we discover the true impact of medical recommendations.”

Yim, who applied to residency programs in physical medicine and rehabilitation, said the experience working with Epling and Rockwell strengthened his ability to think critically about clinical questions.

“I feel like they taught me so much in terms of how to think like a researcher, how to ask questions, how to think through designing studies,” he said. “I feel like I grew so much from my time with them.”

Epling said: “Isaiah demonstrated the kind of thoughtful problem-solving and determination that will serve him well in clinical practice. He’s also been a strong example for the junior students in our research group.”

Receiving a Letter of Distinction, Yim said, reflects a team effort.

“It’s a great honor, something that I’m very thankful for. It reflects not only my hard work, but also just the efforts of the people who really poured themselves into working with me.”

VTCVSOM Medical Student Research Symposium

The Virginia Tech Carilion School of Medicine Student Research Symposium will be held March 26, 2026, from noon to 5 p.m. The event highlights student-led research across basic science, clinical research, and community health. Learn more at: https://medicine.vtc.vt.edu/academics/scientist-physician/research-symposium.html