Chronic arm pain

[Narble]

My situation: Chronic pain w/ parasthesias in both arms from fingertips to shoulders for 10+ yrs. Bilateral presentation with no precipitating injury or illness. Otherwise good health. Since 2005 I've been seen by three neurologists, a rheumatologist, two physiatrists, a psychiatrist, two psychologists, and two physical therapists. Normal findings on EMG, NCV, EEG, MRI (brain), and physical exams, plus usual blood and urine tests. So far, no diagnosis, no treatment, and continued pain every day. Pain is between very annoying to very severe, with limits on work and ADL. Can't quite live this way, and at my latest visit to a doctor, a physiatrist earlier this month, I was told to not seek a diagnosis any more and consider CBT to deal with mental health issues associated with living with chronic pain. Already tried therapy but saw no improvement.
My question: Any suggestions as to what to do next?

[Narble]

Thanks for the response. Lupus, Lyme, polio, etc. have all be ruled out based on blood work and exams. Similarly, DVT and related vascular disorders, plus FM, MS, and inflammatory disease have been ruled out. I'm not on any meds either.
My last referral led me to a physiatrist who had no useful ideas regarding diagnosis, and offered no treatment/management. My PCP is at a loss as to what to suggest next. No one is willing to work on pain management in any form with me, and most pain clinics won't accept me b/c I have no diagnosis, and I've been to the pain clinics in my area (PNW) that will see me. Should I consider a visit to an anesthesiologist or psychiatrist?

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
Consult a vascular specialist to rule out deep vein thrombosis, lymphangitis, faulty deep valves of the veins and compartment syndrome since neurological causes have been ruled out.
Another possibility is that it is myalgia or muscle ache. The various reasons for long standing myalgia or muscle ache are lupus, Lyme’s, polio, electrolyte disturbance especially low potassium (so serum electrolytes should be done), dehydration, fibromyalgia, multiple sclerosis, inflammation of muscles or myositis (hence CPK-MB should be done), high eosinophil counts, use of certain drugs like statins, and post viral fatigue syndrome.
Since I cannot examine you and know other related conditions you may be having, nor is a detailed history possible on net, I have listed the various possibilities that should be looked into. Please consult your PCP for primary examination followed by proper referral. Take care!