The patient is a 58-year-old gentleman with one-year history of right arm pain.  He also has a longstanding history of neck pain.  His neurological examination is normal.  He has an MRI that shows some degenerative changes.  I do believe that his symptoms are probably referable to his neck.  However, I do not think that they are severe enough for him to undergo surgery at this point in time.  Perhaps another course of physical therapy may be helpful for him.  I probably would not recommend anymore invasive procedure, such as a spinal stimulator, as this pain really is minimal.  We could still try to treat him with neuropathic pain medications.