** 1. The pain to the hand combined with upper back pain indicates that nerves leaving your spine are being compressed; it is likely happening in or around your lowest cervical vertebrae in the neck, C6 or C7. The compression could be caused by a bulging or herniated disc between the vertebrae, so consult an orthopedic surgeon for necessary examination and investigation [X-ray cervical spine] 2. also occupation can be one culprit for the same: postural dysfunction can cause neck/ back pain 3. General Instructions i. Maintain straight back posture while sitting or standing. ii. avoid bending forwards and lifting weights. iii. sleep on hard mattress. iv. gentle massage v. back exercises: Leg raising in dorsal recumbent position, push ups, swimming. [once acute stage is over] Spine Management: i. Relax the spine completely. ii. Do not lie face down. iii. Lie on your back with pillow under the knee. iv. Lie on the side with a pillow between the knees. v. Distract your mind from the pain, watch television, read light humorous stories, listen to soothing music. 4. A Chiropractor or Osteopath can perform joint and spinal manipulations to release pressure on nerves which may be causing referred shoulder pain. PS. People who have osteoporosis, spinal cord compression, or inflammatory arthritis, or who take blood-thinning medications should not undergo spinal manipulation. In addition, patients with a history of cancer should first obtain clearance from their medical doctor before undergoing spinal manipulation. 5. following preventive aspect can be tried in GERD to alleviate symptoms: . bland and soft diet, more of milk . avoid hot drinks and spicy food . give small, non-bulky meals more frequently [since GERD causes hiccups/ irritability] . head high position at night. [since GERD causes regurgitation/choking] PS. Management of GERD in adults is based on disease severity, the degree of symptoms, and presence or absence of complications of GERD determined by the diagnostic evaluation.