Could your patient be a good candidate for DNRS referral?

Referral Checklist

Evaluation Checklist
DNRS may be considered as part of a comprehensive care plan with medical evaluation. Note below if persistent symptoms demonstrate features of central sensitization, autonomic dysregulation, heightened threat-response processing, or learned physiological reactivity.

Clinical

• Persistent or recurrent symptoms despite appropriate medical care

• Symptoms began after infection, injury, exposure or significant stress

• Symptoms persist beyond the apparent initiating event

• Symptoms fluctuate significantly over time or by context

Sensitization Patterns

• Multiple sensory, environmental, food or medication sensitivities

• There are an expanding number of triggers

• Symptoms appear disproportionate to the stimulus

• Anticipation or perceived exposure can provoke symptoms

• Stress or routine changes reliably intensify symptoms

Multi-system involvement

• Pain, fatigue or sleep disturbance

• Cognitive symptoms, including brain fog or impaired concentration

• Gastrointestinal, autonomic, dermatologic or respiratory complaints

• More than one body system is involved

Functional impact

• Avoidance of otherwise safe activities, places or environments

• Restricted diet or activity level

• Reduced occupational or social participation

• Difficulty recovering following symptom flares

Treatment context and readiness

• Appropriate medical evaluation has been completed or is ongoing

• Identified medical conditions are being appropriately treated

• Current treatment provides incomplete symptom or functional improvement

• Patient is interested in a structured neuroplasticity-based intervention

• Patient can commit to regular practice and gradual behavioural change

DNRS has been used by individuals living with these and other complex chronic conditions, particularly where central sensitization, persistent physiological reactivity and functional avoidance are present.