[Experiences with the use of pain diaries in the care of outpatients suffering from chronic pain.]. / Erfahrungen mit der Anwendung von Schmerztagebüchern in der ambulanten Versorgung von Patienten mit chronischen Schmerzen.

For the present investigation 31 out-patients suffering from chronic pain received a pain diary, that is a booklet in which they recorded their pain level on visual analogue scales and daily activities several times during a day. We used weekly interviews and the patient's records in the diary to evaluate the patient's compliance and the influence of a pain diary on the pain perception and on the physician-patient-interaction. We found that most of the patients were willing and able to use the pain diary. 30 out of 31 patients kept the diary voluntarily for an average period of 4 weeks. 70% of the patients regarded the pain diary as helpful irrespective of whether or not they considered it at the same time as burden. Only 10% reported difficulties in using the pain diary. The majority of patients (70%) noticed no change by the use of the diary in their general pain perception, about 17% reported to feel an increasing fixation on their pain, while 13% felt more distance from their pain by using a pain diary. The use of a pain diary produces a survey over the pain for a longer period than a usual consultation could present. In particular the relationship between the pain level and other recorded events and activities becomes visible. The apin data become especially clear when displayed graphically in a "pain curve". In this way therapeutic interventions can be checked whether or not they are efficient. Each patient was asked at every meeting to indicate on a separate visual analogue scale the pain level he would consider bearable. This mark was accepted by all patients as their aim for the therapy, a more realistic aim than the expectation of a complete freedom from pain. When observed over a period of at least two weeks we found this mark staying constant with half of the patients. In 23.8% the patients decreased this subjectively bearable pain level more than 1 cm, in 14.3% the level was increased. In 9.5% it varied without any clear tendency. For many patients the pain diary was an impulse for an argument with their pain and life situation. Patients from this study reported a better control over their pain and improved conciousness of their own body. As the patient plays an active part the pain diary promotes an equal cooperation between physician and patient. The new information derived from a pain diary enables both patient and physician to alter their point of view.

[Facial granuloma. On the clinic-histologic extent of variations of finding in 5 patients]. / Granuloma faciale. Zur klinisch-histologischen Variationsbreite der Befunde bei fünf Patienten.

The clinical and histopathological findings are presented in five patients with granuloma faciale. The lesions most often occur on the face and are characterized by single or multiple soft, elevated, well-circumscribed nodules or plaques ranging in color from reddish purple to brown. The sites most commonly affected are the nose, temple, checks and forehead. The etiology of granuloma faciale is unknown. The condition is extremely persistent and may last for many years. Histologically, a narrow zone of uninvolved dermis is usually observed between the epidermis and the dermal, dense, polymorphous infiltrate at all levels of the corium. The infiltrate is usually diffuse or shows a nodular perivascular pattern, consisting of lymphocytes, plasma cells, neutrophils and histiocytes together with a varying number of eosinophils. In older lesions the formation of the fibrous tissue may be seen, accompanied by capillary proliferation. Differential diagnosis includes sarcoidosis, discoid lupus erythematosus, erythema elevatum et diutinum, angiolymphoid hyperplasia with eosinophilia and histiocytosis X. The diagnosis of granuloma faciale requires a synopsis of clinical and histological findings.