Painful neck syndromes are a heterogeneous group of conditions in which many mechanisms may be acting, but in which attention has in particular been directed to two sites of possible pathology: these are the cervical discs and the facet joints. The use of diagnostic nerve blocks has allowed the relative contribution of each site to persistent pain to be determined. In addition to pain arising from joints or discs, there may be muscular pain and pain due to irritation or compression of the cervical or brachial plexus. Secondary hyperalgesia may complicate the clinical presentation and make the precise diagnosis of origin of pain very difficult. Other conditions such as the musculoskeletal pain syndromes and headache syndromes include neck pain amongst the symptoms.