The aim of this study was to investigate the relationship between psychosocial work characteristics and neck and upper limb symptoms and to examine to what extent this relationship could be explained by other risk factors. Data were used from a prospective cohort study in a working population, with a follow-up period of 3 years. The 3-year cumulative incidence rates of neck or upper limb symptoms, neck/shoulder symptoms and elbow/wrist/hand symptoms were 32, 24 and 15%, respectively. After adjustment for potential confounders high job demands was identified as a risk factor for neck/shoulder symptoms (RR: 2.1; CI: 1.2-3.6) and elbow/wrist/hand symptoms (RR: 1.9; CI: 1.0-3.7), and low social support of co-workers was identified as a risk factor for elbow/wrist/hand symptoms (RR: 2.2; CI: 1.0-4.9). Partly, but not exclusively, these relationships were intermediated by an increased exposure to physical risk factors and increased stress symptoms. Personal characteristics did not considerably influence the main effects of the identified risk factors. © 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.