Beyond the Prescription Pad: An Integrative Approach to Chronic Pain in Baltimore

A White Paper from Charm City Integrative Health, Baltimore, Maryland

By Tom Ingegno, DACM. Doctor of Acupuncture and Chinese Medicine at Charm City Integrative Health, Baltimore.

Nearly one in four American adults lives with chronic pain, yet the prevailing model of care still treats it one prescription or one procedure at a time. This paper makes the case for a coordinated, whole-person alternative, and shows what it looks like in practice.

Executive Summary

Chronic pain is now one of the most common health conditions in the United States, affecting roughly one in four adults. Conventional care, built around brief visits, single specialties, and medication, too often manages the symptom without resolving what drives it. In Baltimore, a city that has carried among the nation's heaviest opioid burdens, the limits of a prescription-first approach are especially visible.

Integrative health offers a different model. It combines conventional medicine with evidence-based complementary therapies, acupuncture, physical and movement therapy, behavioral health, nutrition, and mind-body practice, coordinated around the whole person rather than a single symptom. Demand is rising, and national guidelines increasingly recognize several of these approaches as effective, opioid-sparing options for common pain conditions.

This paper lays out the problem, the evidence, and the care model Charm City Integrative Health uses to deliver coordinated, whole-person care, and why it matters for patients, referring clinicians, and employers across the Baltimore region.

• For patients: a plan built around your goals, not just your diagnosis.
• For referring providers: a coordinated, opioid-sparing partner for complex pain.
• For employers: a route to healthier, more present employees.

The Problem: Chronic Pain Is Common, Costly, and Poorly Served

In 2023, 24.3% of U.S. adults reported chronic pain and 8.5% had high-impact chronic pain, pain that frequently limits work or daily life, up from 20.4% and 7.4% in 2019. Prevalence rises steeply with age, reaching 36.0% of adults 65 and older, and chronic pain is closely tied to anxiety, depression, and opioid misuse.

The economic toll is enormous. Chronic pain is estimated to cost the United States at least $560 billion a year in direct medical spending and lost productivity.

Baltimore feels this acutely. The city has recorded the highest opioid overdose death rate of any large U.S. city, about 103 deaths per 100,000 residents. Statewide, overdose deaths have fallen for four straight years to a 10-year low, down roughly 57% from their 2020 peak, real progress driven by naloxone, treatment, and prevention. But the crisis exposed a deeper problem: for years, pain was managed with opioids as a first resort, and the human cost was devastating. Patients and clinicians alike now need pain care that works without defaulting to the prescription pad.

Why Conventional Care Falls Short for Chronic Pain

The standard model is built for acute problems: find a cause, treat it, move on. Chronic pain rarely fits that template. It is shaped by physical, psychological, behavioral, and social factors at once, and a system organized around short visits and single specialties struggles to address them together.

Four gaps recur:

• Symptom-first, not cause-first. Medication can mute pain without touching the muscular, postural, nutritional, or stress-related drivers that sustain it.
• Fragmentation. A patient may see a primary care physician, an orthopedist, a physical therapist, and a counselor who never compare notes, leaving the patient to coordinate their own care.
• Time pressure. A brief appointment leaves little room to understand sleep, stress, movement, and history, the factors that often matter most in chronic pain.
• Over-reliance on medication. When other tools aren't readily available, prescriptions fill the gap, sometimes with escalating risk.

The result is familiar: patients cycle through providers and prescriptions, costs climb, and the pain persists.

What Integrative Health Actually Is

Integrative health is not alternative medicine, and it is not a rejection of conventional care. It is a both-and approach: mainstream medical treatment combined with evidence-based complementary therapies, coordinated around the whole person, body, mind, and daily life.

In practice, that means treating a patient's pain alongside their sleep, stress, nutrition, movement, and mental health, under one coordinated plan rather than a stack of disconnected referrals. The clinician's job is not only to prescribe, but to assemble the right combination of tools for that individual.

Patients are already choosing this model. About 37% of U.S. adults report using at least one complementary health approach in the past year, most often to improve overall health. Use for pain specifically is climbing: among adults who use complementary approaches, the share using them for pain management rose from 42.3% in 2002 to 49.2% in 2022, and the use of yoga for pain more than doubled over the same period. This is mainstream behavior, not a fringe.

The Evidence Base

Integrative care earns its place by being evidence-informed. The strength of evidence varies by therapy and by condition, and honest practice means being clear about that, recommending what the research supports and setting realistic expectations where it is thinner.

Where the evidence is strongest:

• Acupuncture. Major medical bodies, including the American College of Physicians, the American College of Rheumatology, the National Comprehensive Cancer Network, and the NIH, recognize acupuncture as a reasonable non-drug option for several conditions, among them chronic low back and neck pain, knee and hip osteoarthritis, tension headaches and migraines, and cancer-related pain. It is non-addictive and can help patients reduce or avoid opioids.
• Movement and physical therapy. Supervised exercise and physical therapy are first-line, guideline-recommended treatments for most chronic musculoskeletal pain.
• Mind-body practice. Yoga, meditation, and relaxation training have a growing evidence base for pain and for the anxiety and depression that often travel with it.
• Behavioral health and nutrition. Addressing stress, sleep, mood, and diet treats the factors that amplify and sustain pain.

The common thread across the research is that multimodal, coordinated care tends to outperform any single therapy used in isolation, which is exactly what an integrative model is built to deliver.

The Charm City Integrative Health Model

The clinic is built around one idea: a single coordinated plan that draws on the therapies most likely to help each patient, rather than a stack of disconnected referrals.

Each area of care informs the others, and the plan is held by a team that shares one record and one set of goals, so the patient is treated as a whole person, not a sequence of separate complaints.

The six areas of care, coordinated around one plan:

• Medical and pain care: diagnosis, medication, and procedures
• Acupuncture and Chinese medicine: opioid-sparing pain relief
• Movement therapy: exercise and manual therapy
• Behavioral health: stress, mood, and sleep
• Nutrition and lifestyle: diet and daily habits
• Mind-body practice: yoga, meditation, and breathwork

What Care Looks Like at Charm City Integrative Health

A patient's path through the clinic is coordinated from the first visit, not pieced together across disconnected offices.

1. Comprehensive intake. A longer first visit covers medical history, current pain, prior treatments, and the lifestyle factors, sleep, stress, movement, nutrition, that shape it.
2. A personalized care plan. The care team sets goals with the patient and selects the combination of therapies most likely to help, drawing on conventional medicine and complementary approaches together.
3. Coordinated treatment. Providers work as one team around a shared plan, so medical management, acupuncture, movement therapy, and behavioral support reinforce each other instead of competing.
4. Measurement and adjustment. Progress is tracked against the patient's own goals, and the plan is revised as they improve or as needs change.
5. Maintenance and self-management. The aim is lasting capability, equipping patients to manage their own health, not a permanent dependence on the clinic.

For Referring Providers and Employers

Referring clinicians gain a coordinated partner for patients whose pain hasn't responded to a single-specialty approach. An integrative clinic can take on the time-intensive work of multimodal pain management, offer opioid-sparing options that align with current guidelines, and send clear updates back to the referring provider. For complex or high-utilization patients, that coordination relieves pressure on a busy practice.

Employers have a direct stake in chronic pain, which drives absenteeism, lost productivity, and health costs. Whole-person care that keeps employees functional and at work, rather than cycling through specialists and prescriptions, can lower those costs while supporting a healthier, more engaged workforce. Integrative care fits naturally into wellness programs and benefits design.

Conclusion

Chronic pain is too common, too costly, and too complex to manage one prescription at a time. The opioid crisis made the stakes of a narrow approach unmistakable, nowhere more than in Baltimore. The alternative is not exotic: it is coordinated, whole-person care that combines the best of conventional medicine with evidence-based complementary therapies, built around each patient's goals.

That is the work of Charm City Integrative Health.

• Patients: schedule a consultation to build a plan around your goals.
• Referring providers: reach out to coordinate care for your patients.
• Employers: ask how integrative care can support your team.

[Add clinic phone, email, website, and address here.]

Frequently Asked Questions

Sources

• CDC / National Center for Health Statistics, Chronic Pain and High-Impact Chronic Pain in U.S. Adults, 2023, Data Brief No. 518 (Nov 2024).
• Systematic review of clinical practice guidelines on acupuncture for chronic musculoskeletal pain, BMC Complementary Medicine and Therapies (2025), source of the U.S. chronic-pain cost estimate.
• Maryland Matters, Maryland opioid deaths hit 10-year low, down 57% since pandemic peak (May 2026).
• States Newsroom, Maryland opioid deaths hit 10-year low, Baltimore City overdose rate (2024 Big Cities Health Coalition data).
• Nemesure et al., Utilization Rates and Factors Associated with Adoption of Complementary and Alternative Medicine Practices in the US, Journal of Evidence-Based Integrative Medicine (2022 NHIS).
• NCCIH, Use of Complementary Health Approaches for Pain by U.S. Adults Increased From 2002 to 2022 (Nahin et al., JAMA 2024).
• Anthem Clinical UM Guideline, Acupuncture, summary of recognized guideline indications.