The Royal National Hospital for Rheumatic Diseases

The Complex Regional Pain Syndrome (CRPS) Service: Referral & Pathway

CRPS Referral Criteria

Our service accepts referrals locally, nationally and internationally. We will consider referrals for adults aged 18 years and over, who have received a suspected or confirmed diagnosis of CRPS from a medical professional. Patients need to have already exhausted local pain and rehabilitation treatment options without improvement.

All of our services are recognised as national specialist commissioned services by NHS England, so prior funding approval is not required for patients living in England. For people outside of England, then local area funding approval will need to be obtained before a referral is submitted. Private referrals are also accepted.

Referrals should be received in writing from a pain specialist. GP referrals should be submitted through the Choose & Book system. All written referrals should be sent to us at the address below:

CRPS Service Lead
F19
RNHRD & Brownsword Therapies Centre
Royal United Hospital
Combe Park
Bath
BA1 3NG

E-mail: ruh-tr.RNHRDCRPSteam@nhs.net
Telephone: 01225 821127

The Pathway

When we have received a referral from your GP or pain specialist, we will invite you to an assessment with our pain consultant and lead therapist. This consists of two appointments and will cover diagnosis and a discussion of the most appropriate options for you. We may offer advice about changes in medication and lifestyle, or useful techniques that you can practise to help you manage better. After this, you may be invited to attend some further appointments if appropriate.

Please note that the hospital policy is to discharge people from the service should they miss their appointment on one occasion without informing us, or if they cancel their appointments on two occasions.

After the initial assessment process, those suitable will be invited to join our two-week rehabilitation programme. Others who do not need the programme or cannot participate in one may be offered some outpatient follow-ups. If the diagnosis of CRPS is not made, or for those who are unsuitable for our input, recommendations are made to the patient, referrer, and GP. These may include signposting to other, more appropriate services than ours. Whatever the outcome of the assessment, we are always seeking the best outcome for you.

Follow-up review appointments are offered after completion of the programme, the first of which usually occurs at the three-month mark. The standard pathway includes another review at six months post-programme, then 12 months. The majority of patients will then enter our Open Access phase, in which follow-ups are initiated by the patient. This phase usually lasts a year, after which the patient is discharged from the service.

Further reading

UK guidelines for the diagnosis, referral and management of CRPS in adults for primary and secondary care: these have been developed by a panel of experts with support and endorsement from the Royal College of Physicians. The guidelines are designed to help health professionals access the best advice and treatment for patients. Originally published in 2012, a revised 2nd edition of the guidelines was launched in 2018. The full 2nd edition of the UK CRPS guidelines is available to download here – Complex regional pain syndrome in adults July 2018

Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome. Harden, R.N., et al (2010). PAIN, 150(2), pp. 268-274.