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02/03/2005: For months now the pain is more severe. In the beginning I thought that it wasn't real, because mentally I didn't had it very easy considering all the problems from the past half year. Everyone knows that if you don't feel really comfy mentally you will notice this also physically. So that's why I thought that the worsening of the pain wasn't real, but only seemed like that due to me not feeling very well mentally… at least that's how I fooled myself.. As I however started feeling better mentally and the pain didn't get less I no longer could fool myself. So at a certain point I mailed dr. Tisscher about it.

Meanwhile I used tramadol daily next to the fentanyl patches. On the day that I could put a new patch on I used 3 tramadol at a certain moment; one at night before I had to put a new one on, one at noon before I had to put a new one on and one in the evening when I already had put a new one on but the new patch didn't work yet.

Unfortunately dr. Tisscher doesn't think it's a good idea to give stronger fentanyl patches due to my severe MCS. He actually is right, because medicines (= chemicals) aren't that good for (severe) MCS-patients.
I was allowed to use ibuprofen 600mg 3 times a day next to the fentanyl patches. I have discussed this with my gp and my nurse and because ibuprofen has never helped me before we finally choose diclofenac 3 times a day 50mg. This because I have used diclofenac for years without any problems (side-affects) and in the beginning diclofenac has helped me. I honestly have to confess that diclofenac indeed cooperates better with the fentanyl patches then the tramadol does. It appears that tramadol and fentanyl patches work according the same principle and due to this they fight each other. Diclofenac and fentanyl patches however work differently and so they amplify each other and so you got a better pain suppression with this combination then with fentanyl patches and tramadol.

Nonetheless I have regularly severe pain attacks and then I can't do without tramadol, because just then diclofenac does too less. Diclofenac takes care of a complete lower pain level, but tramadol helps me better when having a pain attack; for me tramadol starts slowly working after a half hour. It is though that my pain level is back to about a 9 instead of a constant 10 which was before, thanks to diclofenac. A 9 is always better then a 10, but I still don't like it. I do understand the argument of dr. Tisscher, but always this pain is also no fun. The pain prevents me from doing what I want and I also sometimes question if the choice that has been made is a good choice…

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