Rheumatological / Neurological symptoms: Where to go next?

So many symptoms, so little space. I am a 46 year old man, slim, formerly athletic, otherwise healthy, no drugs or cigarettes, 3 drinks a week.  6'3" 200 lbs.  For three years I have been suffering from severe lower back, SI buttocks, lumbar and neck pain (low back is worst). My elbows are painful to the touch, nerves (esp. calves) constantly twitching/"crawling." Hips and knees hurt.  Pain constantly "shoots" up or down one limb, then another -- goes away then comes back.  Joints throb briefly, then stop.  Legs fall asleep after 30 seconds in a crouch.  Tingling plus chronic sharp "stabbing" pains in my hands and bottom of feet. I cannot sit for more than five minutes without serious low back pain. Always changing positions. Nerves feel "alive."  Feet, fingers and toes often feel close to cramping.  Everything is worse in the morning.  
The nerves in my buttocks, legs and feet feel "cold" when they shouldn't.  Lower back and hips feel sometimes feel "hot" as if inflamed, but MRI shows no back change, no inflamation (inflammation).  I am male, so fibromyalgia?  
I cannot walk long distances.  It sometimes feels I cannot get power to my legs.  All tests (you guessed it!) have been normal.  No Lyme.  No back changes, so no ankylosing spondylitus.  SED, RH, CRP normal.  I have seen several specialists but this thing seems to fall through the cracks. i am at a loss. Can you give me some idea as to where to go next?

[Kevin Pho, MD]

You have had a comprehensive evaluation, with the negative testing ruling out many of the major disorders.  

An ANA level can suggest rheumatologic disease like lupus.  The negative MRI would make central neurologic diseases less likely.

You can consider an EMG and/or nerve conduction studies to evaluate the tingling and shooting pain.  

Metabolic diseases like diabetes, thyroid disorders and B12 deficiency can all be tested for as well.

I would consider a neurology referral - preferably at a major academic medical center.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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