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Chronic painClinical services

Breast Radiotherapy Injury Rehabiliation Service

We're proposing to relocate the pain services currently provided at the Mineral Water Hospital site in Bath, to the Royal United Hospitals' Combe Park site, also in Bath, in 2019. To find out more  click here. 


Radiotherapy is used as part of the treatment process for many forms of cancer.  Radiotherapy - Induced Brachial Plexopathy is damage to the brachial nerve (the nerve that travels down the arm) which can occur following radiotherapy treatment for breast cancer. Depending on the location of the breast cancer, radiotherapy may be delivered to the axillary area (arm pit), chest or neck.  Radiation damage to these nerves is rare, and symptoms/side effects can develop months or even years after treatment – otherwise known as “late effects”.

Advances within radiotherapy treatment allow for more accurate positioning and delivery of radiation to the area with the tumour.   Treatment is carefully planned to ensure that the highest dose is delivered to the tumour for effective treatment, whilst decreasing the dosage to surrounding non-tumorous areas.    

 Symptoms of Radiotherapy - Induced Brachial Plexopathy may include :-

  • tingling, pricking, numbness of the arm / fingers  (parathesia)
  • feelings of “pins and needles”, abnormal sense of touch, such as burning or itching in the arm / fingers (dysesthesia)
  • severe pain in the arm / fingers
  • muscle weakness / complete paralysis of the hand or arm – difficulty performing simple tasks such as opening jars, or containers, holding objects)
  • recurring chest infections / breathing problems – due to radiation induced lung fibrosis (scarring)
  • brittle bones (osteoporosis)
  • swelling of the arm on the side of the treated breast (Lymphoedema)

The Breast Radiotherapy Injury Rehabilitation Service offers specialist multidisciplinary rehabilitation to men and women who are suffering hand or arm pain following radiotherapy treatment for breast cancer.  The service is led by the RNHRD as part of their “living with and beyond cancer” services offered by the hospital.  The service is funded via NHS England  and is supported by Macmillan Cancer.

Why Choose Us?
The service aims are set to provide an assessment for people living with nerve damage following radiotherapy treatment for breast cancer and to help gain: 

  • Improvement in daily function
  • Improvement in quality of life
  • Improvement in pain management

To deliver these aims our multidisciplinary team is made up of internationally renowned clinicians from specialist areas in pain management oncology, rheumatology, lung/respiratory care, psychology, physiotherapy and occupational therapy.

What we offer
A telephone triage by the Lead Nurse is used to assess all patient referrals to the service.  Following this assessment patients who meet the criteria are invited to attend a two day clinic at our specialist centre in Bath.
The two day clinic is arranged as:

Day One
Individual consultations with:- 

  • Pain Physician and Consultant Nurse in pain
  • Oncologist
  • Respiratory Physician
  • Rheumatologist
  • Psychologist
  • Occupational Therapist
  • Physiotherapist

Day Two
Group therapy day provides an opportunity for rehabilitation within a group setting.  The day includes rehabilitation sessions with the Occupational Therapist, Psychologist and Physiotherapist.  There is an opportunity to ask the Oncologist questions and receive answers. 

Assessment at the clinic may lead to referral for an inpatient programme of intensive rehabilitation at the RNHRD.  The inpatient programme is tailored to individual needs and may include psychology, hydrotherapy, physiotherapy and occupational therapy sessions.  Individuals will be referred to local services for further assessments or treatments.

Telephone advice and further follow ups can be accessed by individuals who attend the service. 

Service Outcomes
We are continually evaluating our outcomes to ensure we are delivering the best possible service, information on improvements to patient's conditions following attendace at the BRIRS clinic can be found here.

How to access our service
Individuals are able to self-refer.  Referrals are accepted from any healthcare professional including GP’s, physiotherapy and occupational therapy services.   The service is offered free of charge to all individuals registered with a GP within England who meet the criteria.  Referrals can be accepted from other UK and non UK individuals for which a private price for the service can be provided.

All referrals should be sent to:

Professor Candy McCabe
Royal National Hospital for Rheumatic Diseases
Upper Borough Walls
BA1 1RL  

For existing referral queries please contact Tanya Hawkins (Administrator) on 01225 473 481 or

Learn more

We have produced two short films about the service – please click here to view a patient version, and here to view a clinician's version.