Malin Ernberg

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Verified

Malin verified their affiliation via an institutional email.

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• DDS, PhD
• Professor (Full) at Karolinska Institutet

Background: Understanding of possible periodicity of cytokines, chemokines and growth factors is of great interest and provide valuable information for research into pathophysiological mechanism of inflammatory disease and chronic pain. Significant efforts have been made to identify different analytes in saliva. For precision and accuracy in measur...

Objective: To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR). Methods: An open working group discussion was held...

Background The Restoring Joint Health and Function to Reduce Pain (RE-JOIN) Consortium is part of the Helping to End Addiction Long-term® (HEAL) Initiative. HEAL is an ambitious, NIH-wide initiative to speed scientific solutions to stem the national opioid public health crisis. The RE-JOIN consortium’s over-arching goal is to define how chronic joi...

The present study aimed to assess the effectiveness and functional adverse effects of a single and multiple injections of botulinum toxin A (BoNT-A) for masseter hypertrophy (MH). Twenty-six women complaining about lower third facial enlargement due to MH, received 75 U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3 months, patien...

Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding...

This study aimed to clinically evaluate temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) and the ability to identify and/or predict development of TMJ-deformities over time using cone beam computed tomography (CBCT). The predictive value of self-reported TMJ pain was also assessed. A prospective longitudinal cohort s...

The antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the effica...

Background Awake Bruxism (AB) management includes cognitive and behavioural changes. Digital and analogic tools can be used to remind the individual to control/avoid AB behaviours. However, no study addressed both tools together. Objective To compare the efficacy of the combination of digital (smartphone application) and analogic (adhesive reminde...

The literature on Temporomandibular Disorders (TMD) incidence commonly reports sociodemographic factors such as gender and age. However, the role and prevalence of other sociodemographic factors in TMD are not well defined. Therefore, this scoping review aimed to report the prevalence of sociodemographic factors in TMD patients. A systematic search...

Mastication myalgia is the most common cause of non-odontogenic pain in the orofacial region and is often associated with a reduced quality of life. The purpose of this review is to provide an overview of the clinical aspects of myalgia based on available research. The review includes epidemiological, diagnostic, and etiological aspects. In additio...

Background It has been reported that botulinum toxin type A (BoNT-A) produces structural changes in masticatory muscles. However, not all histomorphometric parameters affected by BoNT-A parameters have been assessed. This study investigated the histomorphometric changes in the masseter muscle of rats after a single injection of BoNT-A.Methods Forty...

Fibromyalgia (FM) is a complex disorder and a clinical challenge to diagnose and treat. Microdialysis is a valuable tool that has been used to investigate the interstitial proteins and metabolites of muscle in patients with fibromyalgia. The implantation of the catheter in the muscle causes acute tissue trauma and nociception. The aim of this study...

Dysfunctional top-down pain modulation is a hallmark of fibromyalgia (FM) and physical exercise is a cornerstone in FM treatment. The aim of this study was to explore the effects of a 15-week intervention of strengthening exercises, twice per week, supervised by a physiotherapist, on exercise-induced hypoalgesia (EIH) and cerebral pain processing i...

Introduction About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for...

This study assessed the long-term effects of botulinum toxin type A (BoNT-A) in subjective pain, pain sensibility, and muscle thickness in persistent myofascial temporomandibular-disorder pain (MFP-TMD) patients. Fourteen female subjects with persistent MFP received BoNT-A treatment with different doses (10U-25U for temporalis muscle and 30U-75U fo...

This study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a s...

To demonstrate if botulinum toxin type A (BoNT-A) improves mandibular range of motion and muscle sensibility to palpation in refractory myofascial pain (MFP) patients. METHODS: Eighty consecutive female subjects with refractory MFP, were randomly divided into four equal groups (n=20): BoNT-A low (BoNTA-L/10 U in each temporalis and 30 U in each mas...

The aims of this study were (1) to compare the levels and interactions of several plasma proteins in patients with myogenous temporomandibular disorders (TMDM) compared to healthy and pain-free controls, (2) to compare the levels and interactions in two TMDM subgroups, myalgia (MYA) and myofascial pain (MFP), and (3) to explore associations between...

Monitoring the immune system’s regulation and signaling using saliva could be of interest for clinicians and researchers. Saliva, a biofluid with close exchange with serum, is influenced by circadian variance and oral factors such as masticatory function. This study investigated the detectability and concentration of cytokines and chemokines in sal...

Fibromyalgia is characterized by widespread musculoskeletal and joint pain, stiffness, fatigue, and sleep and mood disorders. However, the involvement of the immune system in the pathways of fibromyalgia is unclear. The aim of this study was to explore the role of the immune system in comparison with healthy controls and in association with clinica...

Background: Several studies have reported an association between temporomandibular disorder pain (TMD-P) and emotional disorders in children and adolescents. However, no studies have reported if self-reported TMD-P in Saudi Arabia is associated with psychosocial symptoms. Therefore, the current study aimed to evaluate the association between self-r...

Background: Although many children with juvenile idiopathic arthritis (JIA) develop arthritis and deformity of the temporomandibular joint (TMJ), many go undetected. Objective: This study investigates whether findings from patient history and clinical examination using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) ca...

Aims: (1) To deepen knowledge on how specialized health care professionals (HCPs) reflect on encounters with children diagnosed with juvenile idiopathic arthritis (JIA) and (2) to outline a theory for orofacial care. Methods: Grounded theory was used to discover the psychosocial processes involved in communication between HCPs, children, and par...

Purpose: Fibromyalgia (FM) is a complex pain condition, and exercise is considered the first option of treatment. Few studies have examined the effect of exercise on molecular mechanisms in FM. The aim of this study was to analyze the plasma proteome in women with FM and healthy controls (CON) before and after 15 wk of resistance exercise. This st...

Nocifensive behavior induced by injection of glutamate or nerve growth factor (NGF) into rats masseter muscle is mediated, in part, through the activation of peripheral NMDA receptors. However, information is lacking about the mechanism that contributes to pain and sensitization induced by these substances in humans. Immunohistochemical analysis of...

The impact of comorbidities in fibromyalgia (FM) and temporomandibular disorders (TMD) have been well documented, but whether TMD sub-diagnoses myalgia (MYA) and myofascial pain with referral (MFP) differ regarding comorbidity is unclear. We aimed to elucidate this by studying the presence and associations of comorbidities in FM, MFP and MYA. An ex...

The neurophysiological mechanisms underlying NGF-induced masseter muscle sensitization and sex-related differences in its effect are not well understood in humans. Therefore, this longitudinal cohort study aimed to investigate the effect of NGF injection on the density and expression of substance P, NMDA-receptors and NGF by the nerve fibers in the...

Objective The aim of this study was to thoroughly phenotype a group of chronic tension-type headache (CTTH) patients. Methods Fifteen CTTH patients diagnosed according to the ICHD-3 and 15 healthy controls were included in this study. Furthermore, 70 healthy controls were included to establish normative values. Quantitative sensory testing (QST),...

Background: The aim of this study was to investigate if single nucleotide polymorphisms (SNPs) related to monoaminergic neurotransmission, in particular the serotonergic pathway, contribute to pain perception in patients with temporomandibular disorder (TMD) myalgia and if there is a correlation to jaw function as well as psychosocial factors such...

Background The aim of this study was to investigate if intramuscular injection of sterile water can be used as a human experimental pain model that resembles clinical craniofacial muscle pain, and to analyze if the effects differ between sexes. Methods This randomized, double‐blind, placebo‐controlled cross‐over study included 30 healthy age‐match...

Aims: To study the effect and cost-effectiveness of jaw exercise treatment in patients with masticatory myofascial pain. Methods: A total of 97 patients with myofascial pain according to the RDC/TMD were randomized into three groups: (1) jaw exercises; (2) stabilization appliance; or (3) no treatment. After 3 months, the patients were evaluated...

Abstract Background Different pain syndromes may be characterized by different profiles of mediators reflecting pathophysiological differences, and these alterations may be measured in a simple saliva sample. The aims of the current study were to compare concentration of glutamate, serotonin (5-HT), nerve growth factor (NGF), brain-derived neurotro...

The neurophysiological mechanisms underlying NGF-induced masseter muscle sensitization and sex-related differences in its effect are not well understood in humans. Therefore, this longitudinal cohort study aimed to investigate the effect of NGF injection on density and expression of substance P, NMDA-receptor and NGF by the nerve fibers in the huma...

Background: Glutamate, as well as nerve growth factor (NGF), is involved in nociception from peripheral tissues, such as muscles. However, the potential interaction between glutamate and NGF still remains unclear. This study investigated the interaction between glutamate-induced masseter muscle pain and NGF-induced allodynia on pain perception and...

Background: In skeletal muscle, free nerve endings are mostly located within the connective tissue. However, the distribution of sensory afferent fibers in healthy human masseter muscle tissues has not been studied. Objectives: Primarily to investigate human masseter muscle nerve fiber densities as well as expression of NR2B-receptors, substance P...

Background: The clinical care of chronic pain requires personalized understanding of the mechanisms involved. Temporomandibular disorders (TMD) are the most common chronic orofacial pain conditions, and oxidative stress has been proposed to be implicated in their pathophysiology, especially in arthrogenous TMD. However, few studies have explored o...

Fibromyalgia (FM) is a complex pain condition where the pathophysiological and molecular mechanisms are not fully elucidated. The primary aim of this study was to investigate the plasma proteome profile in women with FM compared to controls. The secondary aim was to investigate if plasma protein patterns correlate with the clinical variables pain i...

Background It has been suggested that botulinum toxin A (BONT‐A) is a safe and effective treatment in relieving pain in patients with persistent idiopathic dentoalveolar pain (PIDP). Objectives This study aimed to systematically evaluate all the available studies investigating the pain‐relieving effects of BONT‐A in patients with PIDP. Methods A...

Background Music is used to evoke audio analgesia during dental procedures, but it is unknown if experimental pain and music interact. This study aimed to explore the multi‐sensory interaction between contrasting types of music and experimentally‐induced muscle pain. Methods In 20 healthy women 0.3 ml sterile hypertonic saline (5.8%) was injected...

Background Primary burning mouth syndrome (BMS) is an orofacial disease with neuropathic characteristics. Psychophysics, such as quantitative sensory testing (QST) are used to sub‐classify neuropathic pain syndromes, but their usefulness in characterizing BMS is not yet clear. Objective The aim of this study was to summarize and to quantitatively...

Background Intramuscular injection of hypertonic saline evokes pain with similar characteristics as clinical myalgia and is thus, considered a valid human experimental model. The aim of this study was to investigate if intramuscular injection of sterile water can be used as a human experimental pain model by comparing it with hypertonic and isotoni...

Objectives The study aimed to investigate salivary levels of nerve growth factor (NGF), brain‐derived neurotrophic factor (BDNF), substance P (SP) and glutamate at five time‐points from morning to afternoon in a well characterized healthy and pain‐free individuals. Material and methods Ten young adults were included. Unstimulated and stimulated wh...

Background: The specific serotonin type 3 (5-HT3)-receptor antagonist granisetron effectively reduces clinical as well as experimental muscle pain and hyperalgesia and with a duration that exceeds that of lidocaine. Hence, it may be an alternative to lidocaine as a local anesthetic. There are also some indications that granisetron in addition to 5-...

In the last years, several attempts have been made to study specific biological markers of temporomandibular disorders (TMD). So far, no laboratory tests have been appropriately validated for the diagnosis and prognosis of these disorders. This study aimed to investigate the proteomic profile of the whole stimulated saliva of TMD myalgia patients i...

Background and Objectives Non‐specific low back pain (LBP) is responsible for triggering increased biomarkers levels. In this way, photobiomodulation therapy (PBMT) may be an interesting alternative to treat these patients. One of the possible biological mechanisms of PBMT involved to decrease pain intensity in patients with musculoskeletal disorde...

Purpose: Physical exercise is increasingly being promoted by healthcare for chronic pain conditions with beneficial outcomes such as: pain and fatigue reduction, and increased quality of life. Nevertheless, knowledge about biochemical consequences of physical exercise in chronic pain is still relatively poor.The endocannabinoid system has been sug...

This study investigated if repeated buffered acidic saline infusions into the masseter muscles induced muscle pain and mechanical sensitization. Fourteen healthy men participated in this double-blind, randomized, and placebo-controlled study. Two repeated infusions (day 1 and 3) were given in the masseter muscles with either a buffered acidic salin...

Background: Both temporomandibular disorders myalgia (TMDM) and fibromyalgia (FM) have been linked to central and peripheral changes in serotonin availability. The precursor of serotonin, tryptophan (TRP), is mainly catabolized via another pathway to produce kynurenine (KYN), but whether changes of this pathway are present in TMDM and FM are still...

Background: The pathophysiology of fibromyalgia includes central and peripheral factors. Neurotrophins, such as nerve growth factor and brain-derived neurotrophic factor, are involved in peripheral and central nervous system development of pain and hyperalgesia. Few studies have examined circulating nerve growth factor and brain-derived neurotroph...

Introduction: Proteomics is a powerful approach for biochemical research because it directly studies the main functional components of biochemical systems. The understanding of the normal fluctuations of the proteome in health is essential to identify pain-specific biomarkers. Objective: To investigate fluctuations of the plasma proteome in heal...

Aims: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. Methods: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this D...

Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreo...

Background The most common non‐dental pain in the orofacial region is pain associated with temporomandibular disorders (TMD) and jaw exercises is a common treatment in these cases. Since masticatory myofascial pain has components of an affective and cognitive nature, knowledge about the patients′ experiences of the condition and treatment is import...

OBJECTIVE: Studies have shown it is possible to elicit a tension-type headache episode in 15 to 30% of healthy individuals following a tooth-clenching or stress-inducing task. Despite this, no studies have attempted to understand why some healthy individuals develop a headache episode while others do not. METHODS: The present randomized, single-bl...

Background Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition...

Background: Since children and adolescents are frequently experiencing emotional and behavioral consequences due to pain, their parents should be aware of this emotional and behavioral status. Therefore, the aim of this study was to analyze and describe the parents' reports of the emotional and behavioral status of children and adolescents with di...

Aims: To investigate whether static jaw clenching can activate endogenous pain modulation and to compare the magnitude between healthy individuals and patients with temporomandibular disorder (TMD) myalgia. Methods: Thirty-three healthy volunteers (17 women and 16 men) and 20 women with TMD myalgia participated. Exercise-induced hypoalgesia (EIH...

Perspective: This study reports about elevated plasma levels of endocannabinoidome lipid mediators in FM. The lipids suitability to work as biomarkers for FM in the clinic were low, however their altered levels indicate that a metabolic asymmetry is ongoing in FM, which could serve as basis during explorative FM pain management.

Background: Health and physical capacity are commonly associated with disease, age, and socioeconomic factors. The primary objective of this study was to investigate the degree to which physical capacity, defined as muscle strength and walking ability, is decreased in women with fibromyalgia (FM), as compared to healthy women, who are matched for...

The aims of this study were to compare circulating cytokines between FM and healthy controls and to investigate the effect on cytokine levels by 15 weeks of progressive resistance exercise or relaxation therapy in FM. Baseline plasma cytokine levels and clinical data were analyzed in 125 women with FM and 130 age-matched healthy women. The FM women...

Table A: the table shows OPLS regression of mean PPT using cytokines as regressors in all subjects taken together and in CON. VIP > 1.0 is significant. The sign of CoeffCS and p(corr) shows the direction of the correlation. Thus, negative values indicate that this variable is low in FMS and a positive value that this variable is high in FMS. The th...

Saliva is often neglected as a body fluid of diagnostic or prognostic value, even though generally well accepted by the patients. This is due to lack of a standardized collection procedure. The aim of this study was to identify the ideal saliva collection technique and develop new sensitive methods to detect and analyse markers related to pain in h...

Painful posttraumatic trigeminal neuropathy (PPTTN) is a chronic condition that is difficult to endure and has a poorly understood pathophysiology. Treatment options are limited and often unsatisfactory due to insufficient efficacy and significant adverse effects. Botulinum toxin type A (BTX-A), initially used in the management of pathologically su...

Aims: To investigate patients' experiences of therapeutic jaw exercises for treating masticatory myofascial pain. Methods: A total of 10 patients were selected for the interview study. All patients had received treatment with jaw exercises at a specialist clinic. Semi-structured interviews were conducted in a nonclinical environment according to...

Objectives: Resistance exercise results in health benefits in fibromyalgia. The aim of this study was to determine the factors that mediate change in muscle strength in women with fibromyalgia as a result of resistance exercise. Methods: Sixty-seven women with fibromyalgia (age range 25-64 years) were included. Tests of muscle strength and quest...

Aims: To deepen knowledge of how parents of children diagnosed with juvenile idiopathic arthritis (JIA) perceive the orofacial manifestations of the disease, its treatments, and their encounters with dental care providers. Methods: A total of 15 interviews with parents of JIA patients (3 to 16 years old) with orofacial pain were analyzed accordi...

Background Physical exercise is troublesome for most patients with fibromyalgia (FM) due to activity-induced pain. A reason for activity-induced pain is a low pain threshold. In the present study we investigated if experience of physical activity changed after 15-week progressive person-centred resistance exercise. The control group participated in...

This chapter focuses on the potential role of biomarkers for masticatory muscle pain, i.e., myalgia. To date, no biomarkers have been identified that can be used clinically for diagnosis or treatment of myalgia of jaw muscles. There is evidence from microdialysis studies that intramuscular levels of glutamate and serotonin are elevated in patients...

Background Chronic pain and fatigue improves by exercise in fibromyalgia (FM) but underlying mechanisms are not known. Obesity is increased among FM patients and associates with higher levels of pain. Symptom improvement after aerobic exercise is affected by body mass index (BMI) in FM. Metabolic factors such as insulin-like growth factor 1 (IGF-1)...

Chronic pain is associated with dysfunctional endogenous pain modulation, involving both central opioid and serotonergic (5-HT) signaling. Fibromyalgia (FM) is a chronic pain syndrome, characterized by widespread musculoskeletal pain and reduced exercise-induced hypoalgesia (EIH). In this study, we assessed the effects of three functional genetic p...

The objective of this study was to study possible ethnic differences in steroid hormones and sex hormone-binding globulin (SHBG) during the menstrual cycle. Serum levels of the ovarian steroids estradiol (E2) and progesterone (P) and of follicle-stimulating hormone (FSH), luteinizing hormone (LH), SHBG, dehydroepiandrosterone (DHEA) and testosteron...

Background The aim of this study was to investigate cytokine levels in the masseter muscle, their response to experimental tooth-clenching and their relation to pain, fatigue and psychological distress in patients with temporomandibular disorders (TMD) myalgia. Methods Forty women, 20 with TMD myalgia (Diagnostic Criteria for TMD) and 20 age-matche...

There is evidence that low-grade inflammation may be responsible for pain and development of degenerative changes in temporomandibular joint internal derangement. This article reviews the current knowledge of the molecular mechanisms behind TMJ internal derangements. A non-systematic search was carried out in PubMed, Embase, and the Cochrane librar...

The aim of this study was to investigate experimentally if 5-HT3 single nucleotide polymorphisms (SNP) contribute to pain perception and efficacy of the 5-HT3-antagonist granisetron and sex differences. Sixty healthy participants were genotyped regarding HTR3A (rs1062613) and HTR3B (rs1176744). First, pain was induced by bilateral hypertonic saline...

Data set showing pain variables. (PDF)

Data set showing pain area. (PDF)

Data set showing PPT over time. (PDF)

Approval from the Ethical Review Board. (PDF)

Approval from the Medical Products Agency. (PDF)

Data set showing pain over time. (PDF)

Determination of the variability in the salivary proteome is a prerequisite for the development of saliva as a diagnostic and prognostic tool in particular physiological states. In this context, it is important that technical variability induced by sample collection and processing is kept at minimum to be able to reproducibly assess variability in...

Background Fibromyalgia syndrome (FMS) is associated with central alterations, but controversies exist regarding the presence and role of peripheral factors. Microdialysis (MD) can be used in vivo to study muscle alterations in FMS. Furthermore for chronic pain conditions such as FMS, the mechanisms for the positive effects of exercise are unclear....

Interstitial concentration of glucose. Interstitial concentration of glucose (mean ± SEM; mmol l-1) before and after the 15-week exercise intervention in FMS (upper panel) and CON (lower panel) at the time points 140 (baseline), 160 (immediately after 20-min work period), 180 (recovery), 200 (recovery), and 220 (recovery) min. * denotes significant...

Interstitial concentration of glutamate. Interstitial concentration of glutamate (mean ± SEM; μmol l-1) before and after the 15-week exercise intervention in FMS (upper panel) and CON (lower panel) at the time points 140 (baseline), 160 (immediately after 20-min work period), 180 (recovery), 200 (recovery), and 220 (recovery) min. * denotes signifi...

Interstitial concentration of lactate. Interstitial concentration of lactate (mean ± SEM; mmol l-1) before and after the 15-week exercise intervention in FMS (upper panel) and CON (lower panel) at the time points 140 (baseline), 160 (immediately after 20-min work period), 180 (recovery), 200 (recovery), and 220 (recovery) min. * denotes significant...

Interstitial concentration of pyruvate. Interstitial concentration of pyruvate (mean ± SEM; μmol l-1) before and after the 15-week exercise intervention in FMS (upper panel) and CON (lower panel) at the time points 140 (baseline), 160 (immediately after 20-min work period), 180 (recovery), 200 (recovery), and 220 (recovery) min. * denotes significa...

Interstitial concentrations of the biochemical substances and blood flow at the five time points. In this appendix are MD results reported more in detail i.e. at the five time points during the MD sessions before and after the intervention in the two group of subjects. (PDF)

Interstitial concentration of glycerol. Interstitial concentration of glycerol (mean ± SEM; mmol l-1) before and after the 15-week exercise intervention in FMS (upper panel) and CON (lower panel) at the time points 140 (baseline), 160 (immediately after 20-min work period), 180 (recovery), 200 (recovery), and 220 (recovery) min. * denotes significa...

Blood flow. Blood flow of the trapezius (mean ± SEM; arbitrary units) before and after the 15-week exercise intervention in FMS (upper panel) and CON (lower panel) at the time points 140 (baseline), 160 (immediately after 20-min work period), 180 (recovery), 200 (recovery), and 220 (recovery) min. * denotes significant difference in blood flow at t...

TREND Statement Checklist. (PDF)