Although the most common sources of pain in the neck and upper extremities are musculoskeletal or neurogenic, referred pain from ischemic processes of visceral organs is often confounding. The most common cause of neck pain is cervical strain, characterized by transient cervical pain, stiffness, and posterior cervical muscle spasm. Local application of heat and anti-inflammatory analgesics are generally effective. Lesions of the cervical spinal cord generally result in deep segmental pain that is poorly localized and infrequently influenced by positional changes or Valsalva maneuvers. Tumors of the axial skeleton are commonly metastatic in origin. The thoracic region is the most common spinal location for metastatic disease, and 70% of spinal cord compression cases arise from thoracic cord involvement. Lumbar strain or sprain is the most common source of benign backache. The treatment for spinal stenosis involves analgesics, adjuvant analgesics (antidepressants or antiepileptics), physical therapy, and surgery in appropriate cases.