I'm really sorry that you are in such constant pain. I'm not on Elavil but nortriptyline, a close analgoue. When I asked my neuro about the switch, he backed me off of Lyrica, neurontin was no help for me, he told me that nortriptyline generally has fewer side affects than Elavil. I do get the dry mouth but it doesn't stop me going to sleep. I'm also on tramadol 3x a day.

Cyclelops has a really good point about the skin biopsy. Small fiber disease does not show up on emg or nc studies - these are only useful for large fiber disease. The skin biopsy will at least give you a way to follow the progression or improvement, both do happen, of the PN.
I don't know where you live but people on the forum have had success w/ the neuro group at John Hopkins and I know Melody has frequently commented very highly about the care she and her husband get at Cornell-Weill in NYC. I've been very happy w/ the care I've gotten from the UPenn neuro group in Philadelphia and I understand that the Cleveland Clinic also has a very well respected neuro group although like every place it may take some effort to find a really good neurologist.

I hope you get some relief soon - best of luck.

Alkymst