AI scribe and clinic software for pain management and multidisciplinary pain clinics

The pain assessment, scored and attributed

NICE asks for a person-centred assessment of chronic pain that identifies what contributes to the pain and how it affects the person's life.¹ For chronic primary pain it recommends a supervised group exercise programme, suggests considering acceptance and commitment therapy or cognitive behavioural therapy, and says not to start opioids, gabapentinoids, benzodiazepines, non-steroidal anti-inflammatory drugs or paracetamol to manage it.¹ wai drafts the assessment in that order from the consultation, with the history, the scores, the medicines and the patient's goals each in a fixed field.

Scores and doses carry the follow-up. The Brief Pain Inventory rates pain severity across 4 items and interference with general activity, mood, walking, work, relationships, sleep and enjoyment of life across 7.⁵ The Faculty of Pain Medicine's revised Opioids Aware guidance lowers its oral morphine equivalent threshold from 120 mg to 90 mg a day, with an ideal target of 50 mg a day.³ In the US, the CDC guideline asks clinicians to pause before increasing a total dose to 50 morphine milligram equivalents a day or more, and to add precautions such as naloxone at that level.⁴ The note records each dose and the total as the clinician states it, and the clinician checks the arithmetic.

Procedures have their own rules. For low back pain NICE says not to offer spinal injections, to consider referral for radiofrequency denervation when non-surgical treatment has not worked, the pain is thought to come from structures supplied by the medial branch nerve and localised pain is 5 or more on a visual analogue scale, and to perform it only after a positive diagnostic medial branch block.² wai suggests ICD-10 and SNOMED CT codes from the note, each beside the line it rests on. Typical WHO ICD-10 codes are M54.5 for low back pain, M47.8 for other spondylosis, M54.1 for radiculopathy, M79.7 for fibromyalgia, G50.0 for trigeminal neuralgia and R52.2 for other chronic pain. In ICD-10-CM in the US, low back pain is M54.50 and chronic pain is often G89.29. Procedure codes for blocks and denervation, CPT in the US and OPCS in the UK, stay with the clinic's coder.

The letters a pain clinic sends, and who acts on them

The Academy of Medical Royal Colleges recommends that most outpatient letters are written to the patient with a copy to the GP, and that writing to patients is the default setting for an AI scribe.⁶ In pain medicine the GP copy carries work. A plan to taper an opioid or start an antidepressant is usually carried out by the GP, so the letter must state the current dose, the change, the timetable and who reviews it. wai drafts a medication change letter for exactly that, from the words used in clinic.

Other letters follow the same consultation. A referral letter to pain psychology or a physiotherapy-led exercise programme carries the formulation and the question. A procedure letter sets out the date, preparation, the anticoagulant plan the clinician gave and who to call afterwards. Medico-legal and expert reports in personal injury claims draw on the full history and the scores over time. For the MSK side of the same patients, see the MSK page and physiotherapy.

A multidisciplinary clinic adds one more document, the team summary. Each clinician's findings are attributed to them, and the agreed plan is written once, so the patient's letter, the GP's letter and the team record say the same thing.

Pain described in the patient's own language

wai works in 60 languages, among them English, Arabic, Spanish, French, Portuguese, Italian, Russian, Polish, Turkish, Urdu and Mandarin. English can be mixed in one consultation with Spanish, French, Portuguese, Russian, Italian, Dutch, German, Hindi or Japanese, and the other languages are captured in that language. The signed note is written in English for the record, or in another language the clinic chooses, and the patient's summary can be translated into their language beside it, with crisis and emergency numbers kept exactly as written.

Pain is described in words, burning, stabbing, electric, crushing, and those words carry the mechanism. A patient who describes it in their first language gives a better history, and a taper plan they read in their own language is one they can follow. In a systematic review of 33 studies, 76% found at least one outcome better when patient and physician shared a language other than English.⁸ More is in multilingual consultations.

Clinic software for pain management clinics, from injection lists to opioid reviews

A pain clinic front desk runs two calendars, consultations and procedure lists, and a long tail of reviews. wai Admin brings calls, email, web forms and WhatsApp into one thread per patient and drafts each reply in the clinic's voice for a person to approve. Booking links read each clinician's calendar in Google, Outlook or Apple, so a patient can choose a psychology session, a physiotherapy class or a follow-up, cancellations on a procedure list backfill from the waitlist, and reminders go out.

Reviews are where pain care slips. wai sends recalls for the opioid review, the repeat scores after an injection and the decision visit after a diagnostic block, each message approved by a person. After each visit, the signed plan goes home in plain words and each referral and follow-up is tracked until it is done. Before each visit, the clinician sees a sourced brief of the patient, previous scores, doses and procedures, each fact traced to the letter or visit it came from.

Payments run through the clinic's own Stripe account, with deposits for procedures, invoices, memberships for programmes, payment links and insurer invoices. In the UK, private prescriptions are issued and signed through SignatureRx, and pathology orders and results run through TDL. The full desk is on the clinic management software page.

One pain clinic consultation, start to finish

Take a 52-year-old woman referred by her GP with six years of low back pain, worse on standing and leaning back, with no leg symptoms. Physiotherapy helped for a while. She takes modified-release morphine 30 mg twice a day and codeine 60 mg up to four times a day, sleeps badly and has cut her hours at work. Her Brief Pain Inventory shows an average severity of 7 and an interference score of 6. The consultant examines her, explains that the pain may come from the facet joints, talks through diagnostic medial branch blocks and the risks, and works out aloud that her total is 84 mg oral morphine equivalent a day.

The draft fills the pain template, with the history, red flags asked and answered, the scores, both medicines with doses and the stated total, the examination, the procedure discussion with each risk named and her goal of returning to full-time work. wai suggests M54.5 and M47.8 beside the lines they rest on. The consultant corrects the codeine dose, which the draft gave as 30 mg, adds that she is not on an anticoagulant, confirms the codes and signs.

Three documents go out. A letter to her, copied to her GP, explains the plan in plain words. A medication change letter asks the GP to reduce the codeine over eight weeks on a stated timetable, with the clinic reviewing at the next visit. A referral to the clinic's pain psychologist carries the formulation. At the front desk, she picks a slot on the next block list through a booking link, a deposit is taken through Stripe and a recall is set to repeat her scores two weeks after the block, each message approved by a person.

The evidence behind wai's method

The note is one part of the day the evidence measures. In a randomised trial of 238 outpatient physicians across 14 specialties at UCLA Health, the ambient scribe with a significant effect cut the time spent writing each note by about 41 seconds, against 18 seconds in usual care.⁷ wai is built on that finding, so it takes on the letters, the replies, the procedure bookings and the recalls as well as the note.

Pain medicine's own guidance turns on doses and outcomes. The Faculty of Pain Medicine's dose guidance,³ the CDC's advice to pause before higher doses⁴ and NICE's conditions for radiofrequency denervation² all depend on figures being written down correctly and carried to the next visit. A draft with a field for each dose and score makes a missing figure visible before the clinician signs.

A draft stays a draft until a person signs it. The Academy of Medical Royal Colleges says the clinician checks every document a scribe produces.⁶ wai holds every draft until the clinician signs it, and every reply until a person at the clinic sends it.

Measured in a working clinic. At The Wellness in London, which runs on wai every day, every clinician has 15 hours a week back, as published in the customer story.⁹

Where to start

Start with new patient assessments for one consultant. Load the clinic's template, with fixed fields for scores, each medicine and dose, the stated oral morphine equivalent and the procedure discussion, and run it for two weeks. Count corrections to doses and risks, and time the gap from the end of clinic to signed GP letters.

In the second week, add medication change letters and switch on recalls for reviews after blocks. Read AI scribe error rates before relying on dose fields, see every specialty on the specialties hub, and read about the scribe on the clinical page.

Frequently asked questions