### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have been having severe upper back pain, I went to an after hours clinic because it had gotten so bad, they referred me to a Neurologist he had a CT done and a nerve test done on my hand because it was also giving me alot of issues. He told me I have nerve damage in my arm and my neck has bone spurs and arthritis, but back back hurts worse in my shoulder blade area. He gave me shots in my back which helped for 3 weeks. He has reffered me to an Ortho Surgeon, I do not have heath insurance and they want $ 500.00 up front.  I wonder why my pain is so severe?

### output:

Hi, thanks for writing to Chat Doctor. Propably, you could be having a herniated disc in the cervical spine causing compression over the nerve roots that leads to pain in the scapular region and in the arms. The general treatment guidelines for this problem are as follows -Rest: A soft cervical collar is advisable. It should not be used for more than a week or two as it may worsen the condition with prolonged usage. Medicines: Analgesic are needed in the acute phase. Muscle relaxants are essential for relieving muscle spasms once the acute pain subsides. Neurotrophic vitamins like METHYLCOBALAMINE (activated It B12) or PREGABALIN will help in alleviating the neuropathic pain. Cervical traction: may enlarge the disc space, permitting the prolapse to subside. Intermittent cervical traction for not more than 30 minutes at a time. Weight up to 8 kg can be added. Physiotherapy: Once the acute phase of pain has subsided, Isometric strengthening exercises of the paravertebral muscles are started. Moist heat can be useful Hope this information is helpful. Good day