<s>[INST] Hi, I have earache in my left ear and pain going down the left side of my neck and back of shoulder blade. This started last night but has continued this morning. Painkillers help and I do not have a fever. I have also been taking tamoxifen for the past 3 years. Could ths be muscular? [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. I would explain that your symptoms could be related to a musculo-skeletal pain or a wrong position during sleep. Anyway, considering the fact that you have been taking this drug, I recommend consulting with your attending physician for a physical exam and a cervical spine X ray study. Hope I have answered your query. Let me know if I can assist you further. </s>