Yowsa... what a bummer... It doesn't make it easier, that's for sure, when pain decides to take a break on the date of an appointment. I wonder if your rheumy. would consider seeing you when the pain is at its worst; if there is a cancellation, and you call, possibly, he could see you during that time. I know that some of my most productive or beneficial appointments have been when I've been in pain; during the exams, it seems to give doctors more info. than when I see them and things are feeling semi-okay.

Pain, coupled with other health probs., can definitely lead to fatigue.

I'd take the referral(s) - to either/both a neurosurgeon and an ortho. surgeon.

Do you have a Pain Management doc?