Treating addiction and pain
"I look at the four separate areas, synthesize what's going on in each one, and identify what's missing," he says.
Malinoff then tears off another blank page from the tablet, draws the same four overlapping circles, but labels them body, brain, emotional, and spiritual. These reflect different facets of treatment. For example, he says, many women with fibromyalgia also suffer from psychiatric distress or a sexual trauma. Taking even a "baby step" in one of these areas-which can be as simple as attending a worship service or doing volunteer work-can improve a patient's quality of life.
And for many patients, he prescribes buprenorphine. "It's the most important treatment to come along for both addiction and chronic pain in the past fifty years," Malinoff says of the drug, which has been around since the 1970s and is now sold under the brand names Suboxone and Subutex. Malinoff says he has seen hundreds of patients improve on the medication.
Jason Schwartz, Dawn Farm's clinical director, says "we are big fans of Suboxone for detox" and that the organization works with Malinoff and other doctors who prescribe it. Still, Schwartz adds that Dawn Farm is concerned that the drug is "being used more and more for maintenance." Dr. Mark Greenwald, a Wayne State professor who has studied buprenorphine, says the drug's usefulness as a painkiller is much less established than its effectiveness in helping wean addicts.