An independent provider in the Mid Suffolk area

5. Miss D complains that between 1 February 2023 and 16 April 2024 the Practice wrongly: • ignored and did not investigate her symptoms properly or in a timely way • wrongly diagnosed her cervical radiculopathy as fibromyalgia • wrongly discharged her as recovered and having no spinal problems.

6. She also complains that between 3 September 2024 and 31 December 2025 the Spinal Service at the East Suffolk and North Essex Foundation Trust (the Trust):

• refused to give her an urgent appointment despite her GP’s request • did not offer her surgical treatment for her symptoms • did not give her treatment for her pain • dismissed her symptoms and discriminated against her because of her autism.

7. Miss D says that the way the Practice and the Trust assessed, diagnosed, and treated her symptoms has left her with severe and permanent disability. She tells us she now lives with chronic pain, migraines, loss of hand function, speech difficulties, and is now unable to live independently without support. She says this has caused a significant decline in her mental health, including depression and suicidal thoughts, and that she now needs ongoing support.

8. She explains that the impact on her daily life is substantial. She tells us she has been forced to change jobs, had periods of unemployment, had to reduce her working hours, work from home, and give up further studies, which she says has caused a major loss of income. Miss D says she can no longer take part in hobbies or the social life she once enjoyed and cannot provide the level of care her son needs.

9. Miss D says she now relies on disability aids, and has needed adaptations to her home and a new car. She tells us she experiences ongoing fear and struggles with everyday tasks. She explains that, because she is autistic and has ADHD, the situation has created additional disadvantage for her. She believes that her level of disability would have been avoidable if she had been treated in a timely and appropriate way.

10. As an outcome of her complaint, Miss D wants the Practice and the Trust to take responsibility and apologise for the care she received. She asks for a financial remedy to cover the cost of disabled adaptations, loss of earnings, lost life opportunities, and ongoing care. Miss D also wants the staff to retrain to prevent stereotyping and discrimination. She asks for immediate and appropriate treatment for her pain and disability.

11. Miss D referred herself on 4 January 2023 to the Practice’s musculoskeletal physiotherapy service. She had multiple appointments with them where she was assessed and treated, and later with their back and neck service (BaNS) between 2023 and 2024.

12. The referral notes show she was experiencing knee pain and weakness with stiffness, shoulder pain with arm and hand weakness and numbness affecting grip, and lower back pain worsened by exercise, with a history of cauda equina syndrome. She also reported she has coeliac disease, PCOS, fibromyalgia, ADHD, OCD, anxiety, depression, and suspected autism.

13. On 3 February 2023 Miss D reported widespread chronic pain, fatigue, and weakness. A physiotherapist assessed and treated her, identified no red flag neurological signs, and set a goal to improve mobility and function.

14. On 14 March, Miss D reported ongoing fatigue, a five-year history of neck pain, and stress related symptoms. A physiotherapist assessed and treated her and discussed a management plan covering diet, stress management, exercise, and sleep.

15. On 5 April Miss D presented with an acute flare-up of lower back pain. She was worried that she had another disc injury. The staff reassured her that her symptoms did not sound like cauda equina syndrome. They also suggested seeing a GP for stronger pain relief.

16. At her assessment on 24 May, Miss D reported chronic pain and paraesthesia in her hands and forearms.

17. On 13 June, she presented the Practice with upper limb symptoms which were worsening, and she was concerned about her ability to work.

18. By 29 June, she reported some improvement in her neck pain as a result of her exercises but said her work shifts continued to cause significant pain. A physiotherapist assessed and treated her and recorded some improvements.

19. On 18 August, Miss D reported chronic neck and shoulder pain, arm symptoms, leg heaviness and foot pain. A physiotherapist carried out a neurological examination and found no concerning features. They also treated her and advised on symptom management.

20. On 6 September, Miss D reported chronic neck and shoulder pain, arm symptoms, a pulling sensation in her forearm, reduced finger dexterity, tingling, weakness, and leg numbness. A physiotherapist treated her and discussed treatment options.

21. At her 6 October follow-up, Miss D reported that her neck pain was improving and her shoulder pain was intermittent. A physiotherapist assessed and provided her treatment and advised on how external factors influence pain.

22. On 3 November, she reported continued improvement in neck pain but worsening shoulder pain, and said her hands ached when typing. A physiotherapist noted that neck symptoms remained improved, and her cuff pain had objectively improved but was subjectively worse. They provided her treatment, education and reassurance.

23. On 8 December the records show that her musculoskeletal symptoms were improving. A physiotherapist assessed her, provided her treatment and discussed treatment options, additional services and exercises.

24. On 20 March Miss D discussed her osteoarthritis but said that her symptoms do not fit this diagnosis. The physiotherapist treated her and recorded ongoing low energy and fatigue, multiple joint pain, and prolonged morning stiffness.

25. At her final physiotherapy appointment on 16 April, Miss D reported ongoing fatigue, generalised aches, and neck, arm and foot pain with intermittent tingling. According to the records, she felt confident managing her symptoms independently. The physiotherapist treated her, agreed a care plan, and discharged her.

26. According to her discharge report, her deep arm symptoms did not appear musculoskeletal or spinal in origin. It said her neck pain had improved with stretches and strengthening. The report shows that her upper and lower motor neuron findings were unremarkable, and that if her generalised fatigue and pain persisted, the appropriate referral route may be to pain management services or rheumatology.

27. Following this, Miss D was referred to the BaNS at the Practice who arranged a magnetic resonance imaging (MRI) for her. A multidisciplinary team reviewed the MRI and found she had some foraminal stenosis, a condition that happens when narrowing in parts of spine causes compression of spinal nerves, which explained some of the upper limb symptoms. They said that any decision about surgery would need to be considered very carefully and may require discussion with a neurologist. They then referred her to the Spinal Service at the Trust.

28. On 11 December 2024, Miss D’s GP asked the Trust to expedite her appointment, citing her symptoms and that medication options were limited by polypharmacy. A consultant spinal surgeon refused this, stating there was no neurological deficit, and appointments cannot be expedited for increased pain alone.

29. On 19 December, a consultant neurologist at another trust wrote to the Pain Clinic, describing Miss D as having disabling cervical radiculopathy. They said her spinal MRI showed multilevel nerve‑root compression, but no surgically amenable lesion.

30. On 16 May 2025, Miss D told the Trust she had received no effective treatment despite worsening multi‑level nerve compression, she felt her urgent neurological symptoms were being repeatedly dismissed, and she had been refused surgery. A consultant spinal surgeon replied that her notes and scans did not indicate she needed an urgent appointment so her referral should remain routine. They could find no record she had been refused surgery and said the referral was to discuss potential surgical options.

31. On 22 August, Miss D was reviewed by a consultant spinal surgeon, who noted her long history of neck and back pain, pins and needles in both hands, and the added complexity of autism, ADHD and migraines on her condition. The consultant said her MRI showed age‑related changes with no cord compression and no significant degenerative changes, but did show foraminal stenosis which could explain some problems and is common and may not cause radicular, which is pain that starts at the nerve root in the spine and radiates along the path of a spinal nerve, symptoms.

32. They advised her to continue with her planned pain injections at another hospital, be seen in the Pain Clinic, and return for follow‑up later in the year. The consultant also made a referral request for her to be seen at the Pain Clinic on 27 August.

33. On 28 November spinal surgeons at the other hospital wrote to Miss D’s GP explaining that her recent MRI showed multilevel cervical, lumbar and thoracic spondylosis. It also showed a few small level disc bulges and foraminal stenosis.

38. Before we decide if we should investigate a complaint in more detail, we look at a few different factors. We consider whether there are signs the organisations concerned have got something wrong. We do this by comparing what should have happened with what did happen. If what happened fell far short of what should have happened, we call this a failing.

39. In this case, we saw no indications of failings in the care and treatment the Practice and Trust provided regarding the issues Miss D complained about.

The Practice - physiotherapy investigations and cervical radiculopathy

40. Miss D told us that the Practice ignored the symptoms she was reporting and did not investigate them properly or in a timely way. She is concerned that it dismissed her cervical radiculopathy symptoms as fibromyalgia.

41. The Practice explained that Miss D’s records show that she was extensively listened to about her symptoms and the impact on her life. They said that she was examined neurologically on several occasions with normal findings and that there was no indication that an MRI scan was needed whilst she was in their care.

42. It said that Miss D’s records show that she reported an improvement to her neck pain and her records do not show any clear evidence of signs, symptoms or examination findings fitting with a diagnosis of cervical radiculopathy.

43. The Practice cited the NICE guideline saying it defines cervical radiculopathy as ‘Pain in the neck, shoulder, and/or arm that approximates to that of a dermatome’ and ‘Nerve root symptoms should normally arise from a single nerve root — involvement of more than one nerve root suggests a more widespread neurological disorder’. Dermatomes are areas of skin on your body that rely on specific nerve connections on your spine.

44. It continued by saying that the pain and arm symptoms Miss D described were diffuse, widespread and not confined to a single nerve root distribution and therefore not considered to indicate cervical radiculopathy, meaning onwards referral was not required. Cervical radiculopathy is characterised by one or a combination of loss/alteration of sensation, loss of power and reduced or absent reflexes, the Practice said, and it went on to explain that the clinical findings did not support a cervical radiculopathy diagnosis or the need to refer for an MRI.

45. We considered the relevant clinical guidelines and standards, and relevant clinical physiotherapy reference text with our physiotherapy adviser.

46. The NICE guidance for Neck pain - non-specific states that as part of assessment for non-specific neck pain, which is what Miss D presented with, the practitioner should perform ‘a neurological examination — check power, tone, reflexes, and sensation in the arms and legs.’ It goes on to say that X-rays and other imaging studies and investigations are not normally required to diagnose or manage either non-specific neck pain or cervical radiculopathy.

47. This guidance further notes that a combination of tests can be used to help identify cervical radiculopathy, including the Spurling test. According to Netter’s Orthopaedic Clinical Examination, the Spurling test can be considered a reliable tool for assessing cervical radiculopathy.

48. The Nice CKS guidance for Neck pain – cervical radiculopathy explains that the symptoms of cervical radiculopathy include: • pain in the neck • shoulder and/or arm that approximates to that of a dermatome • sensory symptoms such as absent or altered sensations • motor symptoms such as muscle weakness and spasms • most common nerve roots affected is C7 and C6.

49. It describes the neurological signs of cervical radiculopathy as upper limb weakness, paraesthesia (the feeling of tingling, numbness or ‘pins and needles’), dermatomal, sensory or motor deficit, or diminished tendon reflexes at the appropriate level. It also notes that the condition is most prevalent in 50–54-year-olds.

50. The records show that on 3 February 2023 the physiotherapist checked Miss D’s power, tone, reflexes, and sensation at her initial assessment. On 6 September 2023, a physiotherapist carried out the Spurling test. In this case, the test was negative and therefore did not indicate cervical radiculopathy. There were no indications in the earlier assessments that cervical radiculopathy should have been considered. Miss D’s clinical presentation did not meet the threshold for imaging, and it was therefore not required.

51. We can see from the records that Miss D did not demonstrate typical features of cervical radiculopathy, as she did not show dermatomal pattern sensory changes, and testing did not identify differences in sensation between sides of the body. A physiotherapist carried out dermatomes and myotomes assessments on 24 May 2023 which were both negative. Although Miss D reported symptoms such as numbness and paraesthesia, these were not supported by the findings from the tests.

52. Our physiotherapy adviser notes that Miss D’s presentation was complex with multiple possible contributing factors to her symptoms beyond a purely musculoskeletal cause. These included psychosocial factors such as anxiety about her symptoms, and elements of depression, which could influence pain perception and recovery.

53. Miss D was also taking multiple medications, including atomoxetine and quetiapine, which can be associated with headaches, abnormal sensations, sleep disturbance, muscle rigidity, and movement disorders. She has a pre-existing diagnosis of Hashimoto’s thyroiditis, which can cause generalised aches and pains. In addition, Miss D was 38 years old during this time and therefore not in the typical age group presenting with cervical radiculopathy potentially pointing to other possible causes for her symptoms.

54. The records show that the physiotherapists offered reassurance to Miss D that pain does not necessarily mean physical damage. Our physiotherapy adviser explained that such reassurance is appropriate where psychosocial factors are present. The records indicate that the physiotherapists adopted a holistic management approach addressing both, physiological and psychosocial aspects of her presentation.

55. Our physiotherapist adviser explains that overall, the physiotherapists assessed Miss D thoroughly in line with the guidance set out above. The clinical findings were more consistent with non-specific neck pain rather than cervical radiculopathy.

56. We can see from the records that the staff at the Practice discussed Miss D’s fibromyalgia and its possible link to her symptoms. There are no indications that it had made a clinical finding that her symptoms were due to fibromyalgia. As set out above, the physiotherapists assessed her in line with guidance indicating that the Practice did not dismiss her symptoms as fibromyalgia but investigated them appropriately.

57. For the reasons outlined above, we have not identified indications that the Practice dismissed Miss D’s symptoms or did not investigate them appropriately. As such, we will not be taking any further action on these parts of the complaint. We recognise that Miss D has experienced difficulties with her symptoms and pain, and understandably is seeking answers to these issues.

The Practice - Discharge

58. Miss D says that the Practice discharged her on 16 April 2024 even though she had not recovered and had spinal issues that would need further treatment and investigations.

59. The Practice explained that it had reviewed her neck pain and it had improved with physical exercises. It also said that her generalised deep arm symptoms were assessed and did not appear musculoskeletal or spinal in origin.

60. Our physiotherapy adviser explains that there is no single national guideline specifically governing discharge from physiotherapy, and decisions are often based on clinical judgement and, in some cases, local policy. We can, however, inform our thinking with the NICE guidance for Neck pain – non-specific and Neck pain – cervical radiculopathy, which describes the signs, symptoms and investigations that should be considered as outlined in the previous section of this statement.

61. The physiotherapists carried out appropriate assessments such as the dermatome and myotome testing, deep tendon reflexes, additional neurological screening tests such as Spurling’s, Hoffmann’s, Clonus, and Romberg, which were all normal ruling out more serious neurological causes in line with the NICE guidance. Our adviser says that there was no clinical reason that would prevent discharge.

62. In addition, prior to being discharged, Miss D reported some improvements in her symptoms. The records also show that she indicated she was happy to continue her exercises independently. Our physiotherapist adviser explains that it was reasonable and appropriate to discharge Miss D in these circumstances.

63. We cannot see indications that the Practice discharged Miss D inappropriately and without assessing and investigating her symptoms sufficiently. We will therefore not investigate the matter in detail and will take no further action on it. Again, though, we know Miss D was suffering and our decision is not intended to detract from that.

The Trust - Spinal Service appointment

64. Miss D believes that given the symptoms she was reporting, the Trust should have provided her an urgent appointment rather than a routine one at the Spinal Service when her GP requested it.

65. The Trust says that its spinal consultant wrote to her GP and explained that as her investigations had not indicated any abnormalities they were not going to upgrade the referral as urgent as the GP is able to offer pain management. It said her GP had agreed to try gabapentin to manage her pain.

66. We have reviewed the relevant guidelines and standards with our spinal surgery adviser.

67. NICE guidance for Neck pain - non-specific sets out that red flag features for signs of serious spinal or other conditions include: • neurological symptoms and signs • malaise, fever, unexplained weight loss, or unremitting pain affecting sleep • a history of violent trauma, cancer, neck surgery, or risk factors for osteoporosis.

68. It goes on to state that severe symptoms such as profound weakness of the hands, bowel or bladder dysfunction may indicate more serious pathology.

69. Our spinal surgery adviser explains that it was appropriate for the Trust to offer a routine appointment to Miss D because her clinical presentation did not demonstrate features that would justify an urgent review. There was no evidence of objective neurological issues such as weakness, nor any red flag symptoms including bladder or bowel disturbance.

70. Although Miss D reported pain and some sensory symptoms, these were described as fluctuating rather than progressively worsening, and repeated clinical examinations did not identify any abnormal neurological findings. We can see from the records that imaging and investigations, including scans and nerve conduction studies, were reported as normal, and did not indicate clinically significant abnormality. Our adviser says that these clinical findings did not necessitate urgent input from the Spinal Service.

71. As such, we consider that it was appropriate the Trust to offered Miss D a routine appointment instead of an urgent in line with the NICE guidance. We did not identify indications that anything went wrong in relation to this part of the complaint. We will, therefore, not take any further action on this concern. We acknowledge, however, that it is entirely understandable that given her ongoing suffering, Miss D had hoped for a more timely appointment. We recognise that NHS wait times can be long and frustrating. We hope she feels some assurance that despite this, there was no clinical urgency that warranted an urgent appointment.

The Trust - Surgery

72. Miss D believes that the Trust should have offered her surgical treatment for her condition.

73. The consultant surgeon at the Trust explained on 22 August 2025 that Miss D should continue her planned pain injection treatment at the other hospital and offered to follow up later that year to monitor her progress. They also said she should be seen in the pain clinic as Miss D was keen to follow a holistic approach and discuss ways to manage her pain.

74. NICE guidance for Low back pain and sciatica in over 16s: assessment and management, supports a multidisciplinary approach and non-surgical management where there is no clear structural pathology. NICE guidance for Neck pain - non-specific states that if no red flag symptoms are present the following approaches for treatment and management should be considered: • reassurance • advice and education • analgesics • a physiotherapy referral • advice on exercise options • referral to occupational therapist where appropriate • psychological therapies where appropriate • medication for neuropathic pain.

75. It goes on to say that for people with neck pain for more than 12 weeks, referral to pain clinic should be considered.

76. the evidence base regarding fibromyalgia and surgical outcomes, such as Effects of fibromyalgia symptoms on the outcome of spinal surgery, and Fibromyalgia syndrome – a risk factor for poor outcomes following orthopaedic surgery: A systematic review, Seminars in Arthritis and Rheumatism, indicate that people with fibromyalgia often have poorer results from spinal surgery.

77. We can see from the records that the overall clinical picture of Miss D was not consistent with a condition that would normally be treated with spinal surgery. She reported widespread pain distribution and not localised to a specific nerve root or spinal level, which is more characteristic of conditions such as fibromyalgia.

78. Our spinal surgery adviser explains that Miss D had an established diagnosis of fibromyalgia, alongside mental health factors, and her condition is more likely to be influenced by non-structural factors, including psychosomatic components, rather than an underlying structural spinal pathology.

79. In this context, it was appropriate that she had a multidisciplinary assessment and received physiotherapy over an extended period, in line with the NICE guidance and the evidence from the relevant research.

80. As the scans did not show a clear underlying issue, together with the diffuse and non-dermatomal nature of symptoms, this meant that spinal surgery would not have been expected to provide benefit. Furthermore, fibromyalgia is recognised as a factor associated with poorer outcomes following orthopaedic and spinal surgery.

81. Evidence suggests that surgical intervention in people with fibromyalgia should be approached with caution and that non-surgical management strategies should be tried first. Therefore, it was reasonable for the Spinal Service to proceed with routine assessment rather than prioritising surgical intervention. Our spinal surgery adviser explains that it is unlikely that earlier assessment would have altered the clinical outcome.

82. Our spinal surgery adviser notes that, although a neurologist had previously suggested a possible cervical radiculopathy, the symptoms Miss D reported were not consistent with a single nerve root distribution, and normal nerve conduction studies further reduced the likelihood of a neurological cause.

83. Overall, the records show that Miss D’s symptoms did not indicate a spinal or neurological condition requiring surgical management, and that the care provided, including physiotherapy, investigation, and onward referral to pain services, was appropriate in line with the NICE guidance.

84. As such, we did not see any indications that the Trust’s approach on surgical treatment in these circumstances was inappropriate. For this reason, we will not take any further action on the matter. We hope our explanation helps assure Miss D that although she sadly does continue to experience symptoms, they are not symptoms that require surgical intervention.

The Trust - Pain management

85. Miss D is concerned that the surgeon at the Spinal Service did not put an appropriate pain management plan in place. She believes it was not appropriate to identify significant spinal pathology and neurological symptoms without also providing pain management.

86. NICE guidance for Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain states that ‘the experience of pain is always influenced by social factors (including deprivation, isolation, lack of access to services), emotional factors (including anxiety, distress, previous trauma), expectations and beliefs, mental health (including depression and post-traumatic stress disorder) and biological factors.’

87. It goes on to say that when assessing chronic primary pain and chronic secondary pain, these potential contributors to the presentation should be considered. Overall, the guidance supports the biopsychosocial model in management of chronic pain.

88. The approach the Trust took with pain management was appropriate in line with this guidance. Miss D had already been receiving interventions, including injections, and had been referred to a pain management service. A biopsychosocial approach to managing chronic pain, involving physiotherapy, pain specialists and psychological support had been put in place and there was no expectation that the Trust would have taken any further action.

89. Given the complexity of her condition and the likely contribution of psychological factors, referral to a multidisciplinary pain team with access to psychological support was sufficient. Our spinal surgery adviser explains that there was no additional intervention that a spinal surgeon at the Trust would be expected to initiate beyond this pathway given Miss D’s presentation.

90. For these reasons we cannot see indications that anything went wrong in the Trust’s approach to Miss D’s pain management and will not be investigating this part of the complaint in detail.

Symptoms and autism

91. Miss D tells us that she believes the Trust dismissed her symptoms and discriminated against her because of her autism. She says that this means her cervical radiculopathy was not diagnosed or treated.

92. On 22 August 2025 a consultant spinal surgeon at the Trust noted her long history of low back and neck pain, as well as pins and needles radiating into both hands affecting her right side more than the left. They said this Miss D’s situation is complicated by her other problems including autism and ADHD.

93. In addition to this, we can see from the records that the Trust had noted that Miss D has autism in her clinical background. As we set out in the previous sections of this statement, our physiotherapy and spinal surgeon advisers noted that Miss D had been thoroughly assessed, and her symptoms investigated in line of guidance. She had also been receiving appropriate interventions such as physiotherapy, pain injections and referral to the pain clinic. We cannot see any indications that the Trust based its decisions or actions on Miss D’s autism diagnosis.

94. Because of this we do not see indications that the Trust dismissed her symptoms or discriminated her because of her autism. As such, we will not be investigating the issue in more detail and will take no further action.

95. We recognise that this may not bring Miss D the outcome she seeks. We hope that she is reassured that we have thoroughly assessed her concerns and wish her all the best in finding treatment for her symptoms.

1. We have carefully considered Miss D’s complaint about the Physiotherapy Practice (the Practice) and the East Suffolk and North Essex NHS Foundation Trust (the Trust). We were sorry to hear about her ongoing symptoms, the difficulties she has faced in seeking a diagnosis and treatment, and the impact this has had on her physical and mental health, quality of life, daily functioning, and finances.

2. We considered evidence provided by Miss D, and the organisations involved, as well as clinical advice from a physiotherapist and a consultant in spinal surgery. We have not seen any indications that the Practice fell below the expected standards in its assessments, investigations, or discharge planning. We also did not identify that anything went wrong with how the Trust prioritised her appointment, in its surgical decision-making, pain management planning, or assessing her symptoms.

3. We have therefore decided not to investigate this complaint in detail or take any further action on it.

4. We recognise the significant impact Miss D describes, and our decision does not take away from her experience or the difficulties she has faced.