In a three-year follow-up study, the occurrence of neck and shoulder pain (NSP) in terms of frequency, duration and intensity was investigated in a population of 537 male professional drivers. Over the follow-up period, the cumulative incidences for neck and shoulder pain were 31.9% and 21.4%, respectively. After adjustment for potential confounders, a measure of cumulative whole-body vibration exposure was significantly associated with all NSP outcomes. Lifting loads and work with hands above shoulder level were significantly related to shoulder outcomes, while driving with trunk bent or twisted was associated with neck pain. Limited job decision, low social support and job dissatisfaction were significant predictors of neck outcomes. Psychological distress was associated with all NSP outcomes. The findings of this cohort study suggest that NSP outcomes are of multifactorial origin in driving occupations.