Referral and Pathway Process

We accept referrals locally, nationally and internationally.  The Complex Regional Pain Syndrome (CRPS) service 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.

The referral criteria for the Breast Radiation Injury Rehabilitation Service (BRIRS) is known brachial plexus injury following radiotherapy treatment for breast cancer.

The Complex Cancer Late Effects Rehabilitation Service (CCLERS) will consider referrals for adults aged 18 years and over, who meet the following criteria:

Unresolved persistent pain and reduced physical function due to the consequences of treatment for cancer (any tumour site)

Already seen by local pain and rehabilitation services (i.e. primary/ secondary physiotherapy services) without improvement and/or deterioration in symptoms

Considered complex/ highly complex by local or regional services due to physical and/or psychological needs

Completed cancer treatment more than 12 months ago (excluding hormone therapy)

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 GP or pain specialist.  All referrals should be sent to us at the address below:

Professor Candy McCabe

Clinical Lead – CRPS/ Complex Cancer Late Effects Service

Royal National Hospital for Rheumatic Diseases

Upper Borough Walls

Bath BA1 1RL

Email:  ruh-tr.RNHRDCRPSteam@nhs.net

Telephone:  01225 473462 (CRPS enquiries) or 01225 473481 (BRIRS/ CCLERS enquiries)

Once a referral has been accepted, CRPS patients will be offered a number of outpatient appointments with specialist team members.   BRIRS and CCLERS patients will have a telephone assessment with our nurse specialist and then will be invited to a two-day clinic. 

Following these outpatient appointments, patients may then be offered the opportunity to attend a two week inpatient rehabilitation programme.   This is mainly a group-based programme, but patients will also work individually with the therapy team to enable a more tailored approach to their treatment.  Follow-up review appointments are offered after completion of the programme.

(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).

Short videos about the CRPS and BRIRS services have been produced and are available to view on our homepage.  CRPS patient experience outcome information  can also be downloaded here – CRPS Patient Experience August 2017

Recognised criteria of signs and symptoms (the Budapest Criteria) are used for the diagnosis of CRPS. 

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 on 23rd July 2018.  The full 2nd edition of the UK CRPS guidelines is available to download here – Complex regional pain syndrome in adults July 2018