Degenerative changes are considered to be a common cause of neck pain. In addition to this cause, personality traits could contribute to the complaint of neck pain. We investigated the associations of neck pain with personality traits, disc degeneration and osteoarthritis (OA) on radiographs of the cervical spine in a general population of 5,440 men and women between 20 and 65 years of age. Disc degeneration was associated with neck pain in the men but not in the women. OA of the facet joints was not related to neck pain, either in the men or the women, but the personality traits, neuroticism and injuredness, were. Among those with severe disc degeneration or OA of the cervical spine, neuroticism was a strong independent determinant of pain. Our findings show that neuroticism is a more powerful determinant of neck pain than radiological signs of disc degeneration or OA in the general population.