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.

This chapter describes current knowledge about two drug treatments of depression, anxiety, pain and sleep disorders as these psychiatric syndromes often accompany the functional somatic syndromes. Monoamine oxidase inhibitors (MAOIs) came from the antitubercular drug iproniazid that appeared to alleviate depression in patients with tuberculosis. Psychotic depression, i.e., major depression with delusions and/or hallucinations, responds better to a combination of an antidepressant and an antipsychotic than to either drug given separately. Short-lived anxiety suggests use of benzodiazepines with shorter half-lives, while with the longer lasting anxiety, benzodiazepines with longer half-lives could be used. Antidepressants such as tricyclic agents, selective serotonin reuptake inhibitors and trazodone have shown usefulness for patients with generalized anxiety disorder. All the benzodiazepines used for anxiety also serve as hypnotics. Carbamazepine, an anticonvulsant agent, has shown efficacy especially for neurogenic pain, at doses of 200-1200 mg/day, in divided doses.