If you haven't already tried this, please please consider taking 1+ grams of fish oil supplements a day plus a B complex vitamin. I was headed for surgery but I found a new doctor who recommended this and it has GREATLY reduced my pain. I still get some discomfort from overuse, but as I type this, I'm having a difficult time remembering the last day I hurt enough to wear my compression bands during the day (which also help a huge amount, by the way - ACE makes a good set of wrist wraps).
Seems like the longer I'm on the fish oil and B vitamins, the better the baseline pain gets...
My new biking mantra:
I am attached to my bike. If I start to slow down, I need to unclip. If I do not unclip, I will fall. If I unclip, I will hurt myself less if I do fall.