The Medication List Says Everything: Benjamin Monti on Chronic Pain, Polypharmacy, and What Acupuncture Can Untangle

The first thing Benjamin Monti does when a new chronic pain patient sits down isn't check their range of motion or ask where it hurts. He asks to see their medication list. What he finds there — the contradictions, the redundancies, the side effects being treated as new diagnoses — tells him more about what's gone wrong than any single symptom could.

Monti is a licensed and doctoral-level acupuncturist running Competitive Edge Acupuncture in Berlin, Maryland. His background blends traditional Chinese medicine with a methodical, almost forensic approach to the clinical picture. He doesn't treat pain — he investigates it.

The Problem Hiding in the Prescription Pad

This is a problem with a name: polypharmacy. A systematic review in BMC Geriatrics documented the cascading risks of multiple concurrent medications — drug interactions, adverse effects treated as new conditions requiring additional prescriptions, and patients losing track of why they're taking what they're taking.^[3] Monti sees it firsthand. The patient came in for back pain. They're now on an opioid, an NSAID, an SSRI for the depression the pain caused, and a statin that may or may not be related. Nobody has stepped back to ask whether the pain itself was ever properly understood.

The American College of Physicians has explicitly recommended nonpharmacologic therapies — including acupuncture — as first-line treatment for chronic low back pain, precisely because the pharmacologic approach has produced diminishing returns and mounting complications.^[4] What Monti describes isn't an edge case. It's the standard trajectory for millions of chronic pain patients who enter a system designed to manage symptoms rather than resolve their source.

Where the Pain Actually Lives

The insight here is deceptively simple: pain lives in the imbalance, not the injury. When one muscle group is chronically tight and its opposing group is weak, the joint between them bears the cost. An updated individual patient data meta-analysis in The Journal of Pain — the largest of its kind — confirmed that acupuncture produces clinically meaningful improvements in chronic pain conditions, with effects that persist well beyond the treatment period.^[1]

What makes Monti's framework distinctive is how precisely he maps the traditional Chinese medicine channel system onto modern musculoskeletal anatomy. The Tai Yang channel — encompassing the Bladder and Small Intestine meridians — runs along the posterior chain, directly overlapping with the hamstrings and paraspinal muscles that practitioners like Logan Engelstad also identify as central to back pain. Research in The Lancet has confirmed that the vast majority of low back pain is "non-specific" — meaning imaging findings rarely explain the symptoms, and the functional relationships between muscle groups matter more than structural abnormalities.^[2]

This is where conventional treatment often goes sideways. An MRI shows a disc bulge, a surgeon recommends intervention, and meanwhile the actual driver — a weak glute medius, a locked-up TFL, hamstrings doing the work of muscles that have checked out — goes unaddressed. Understanding what an acupuncturist actually evaluates reveals a fundamentally different diagnostic lens, one that prioritizes function over structure.

Testing Both Sides of the Equation

"Only half of the problem" — that phrase captures Monti's entire philosophy. Releasing the tight muscle feels good in the moment. But if the weak muscle that caused the tightness in the first place remains untested and untreated, the pain returns. It's a pattern that David Salgado has also observed in his traditional medicine practice: treating one side of an imbalance without addressing the other is treating a symptom, not a cause.

Emerging research on central sensitization supports this systems-level thinking. A 2021 review in the Journal of Orthopaedic & Sports Physical Therapy argued that chronic musculoskeletal pain frequently involves maladaptive central nervous system changes that perpetuate pain long after the original tissue insult has healed.^[5] The implication: you can't just treat the site. You have to treat the system. That's what Monti does — tonifying where there's deficiency, sedating where there's excess, and always testing both sides of the muscular equation.

For anyone caught in the cycle of medications, imaging, and interventions that never quite resolve the pain, Monti's approach offers a different entry point. Start with the medication list — understand what's layered on top of what. Then look at the muscles — not just where it hurts, but what's weak on the other side. The best practitioners for chronic pain share this commitment to finding the imbalance before reaching for the next prescription. The answer might not be adding something new. It might be understanding what's already there.