I saw Jerry, my GP, today about the mess of problems. It's a matter of working out which bit to work on changing first, since the depression, anxiety, insomnia, fatigue and pain all feed off and reinforce each other. So, first step: from today, increasing my bedtime antidepressant from 30 mg mirtazapine to 45mg. This may improve my mood, help me sleep, encourage my appetite and - just possibly - being a NaSSA it may help synergistically with my pain.
I'm to check in with him in no more than a month's time to review progress. If my pain is still bad then, he'll up my fentanyl dose from 50 μg to 75 μg/hr. If so, hopefully I'll be able to shift my morphine intake back down again to more sensible levels.
He's also going to chase up the pain clinic to find out why I haven't had even a review from them in three years, let alone any treatment. I know that their service was seriously dislocated when Richard Walker had to retire suddenly on health grounds, but... three years is a long time to live without effective support. Yes, I probably should have yelled about it earlier, but it wasn't until the beginning of this year that the pain started to get noticeably and progressively less easy to bear.
Anyway. Progress, to some extent, and the knowledge that I've done the right thing in yelling for help, even if I did take too long about doing so :)
Special thanks to the wonderful l0u_1s3, everyone at Willow View (especially Bet, Ben, Sylv and Caroline) and most of all my amazing and lovely stgpcm.