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Im sorry to hear about Sam, i know how hard it is to watch your dog in pain. My small mixed breed almost died from pancreatiasis but 2 days at the vet and $1800 dollars later she is back to her old self.
I dont really have any ideas what it is, i will ask around though and let you know. I just wanted to warm you about Sam being on pain meds on a daily basis. While it is helping him it can be weakening his kidneys also because they are processing it everyday. Im sure your vet warned you about this. I would see if there is something you can give him to help the kidneys.
Good luck with him and keep us posted. Oh and i would also call around to different specialists.
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