| 1. |
- Canales, Giancarlo De La Torre, et al.
(författare)
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The role of tryptophan and its derivatives in musculoskeletal pains : A systematic review and meta-analysis
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842. ; 51:9, s. 1898-1910
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Forskningsöversikt (refereegranskat)abstract
- Background: Studies present ambiguous findings regarding the role of tryptophan and its metabolites, kynurenine and serotonin in chronic musculoskeletal pain. This systematic review aimed to investigate the expression of tryptophan and its metabolites, serotonin and kynurenine in patients with local and generalized chronic musculoskeletal pain in comparison with pain-free controls.Methods: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL) and Web of Science for clinical and observational trials from the beginning of each database to 21 April 2023. Out of 6734 articles, a total of 17 studies were included; 12 studies were used in the meta-analysis of serotonin, 3 regarding tryptophan and 2 studies for a narrative synthesis regarding kynurenine. Risk of bias was assessed using the quality assessment tool for observational cohort and cross-sectional studies of the National Heart, Lung, and Blood Institute, while the certainty of evidence was by GRADE.Results: All included studies showed a low risk of bias. The meta-analysis showed lower blood levels of tryptophan (p < .001; very low quality of evidence) and higher blood levels of serotonin (p < .001; very low-quality evidence) in patients with generalized musculoskeletal pain, when compared to pain-free individuals. In local chronic musculoskeletal pain, there were higher blood levels of serotonin (p=.251; very low quality of evidence) compared to pain-free individuals. Regarding kynurenine, the studies reported both higher and lower blood levels in generalized chronic musculoskeletal pain compared to pain-free individuals.Conclusions: The blood levels of tryptophan and its metabolites serotonin and kynurenine seem to influence chronic musculoskeletal pain.
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| 2. |
- Christidis, Nikolaos, et al.
(författare)
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Early steps towards professional clinical note-taking in a Swedish study programme in dentistry
- 2022
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Higher education tends to focus on academic writing only, instead of emphasizing that professional texts are also used as a basis for communication in contexts with a variety of participators. When it comes to clinical notes, research is scarce and focused on technology and informatics. Therefore, the aim was to explore dental students’ clinical notes, and specifically which aspects of the clinical notes characterizes clinical notes that are not sufficient enough for professional purposes.Methods The object of analysis was the student’s written completion of a teacher constructed protocol regarding oral mucosa, the dental apparatus including pathology on tooth level, oral hygiene, and a validated international clinical examination protocol of the temporomandibular region. The study was framed within the New Literacy Studies approach, and the clinical notes were analyzed using thematic analysis.Results Within the clinical notes three themes were identified; a) familiar content; b) familiar content in new context; and c) new content. The forms of notes could refer to either categorizational clinical notes or descriptive clinical notes. Most students were able to write acceptable clinical notes when the content was familiar, but as soon as the familiar content was in a new context the students had difficulties to write acceptable notes. When it comes to descriptive notes students suffered difficulties to write acceptable notes both when it came to familiar content, or familiar content in a new context.Conclusions Taken together, the results indicate that students have difficulties writing acceptable notes when they are novices to the content or context, making their notes either insufficient, too short or even wrong for professional purposes. With this in mind, this study suggests that there is a need to strengthen the demands on sufficient professional quality in clinical notes and focus on clinical notes already in the early stages of the different medical educations.
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| 3. |
- Christidis, Nikolaos, et al.
(författare)
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Pharmacological Treatments of Temporomandibular Disorders : A Systematic Review Including a Network Meta-Analysis
- 2023
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Ingår i: Drugs. - : Springer. - 0012-6667 .- 1179-1950.
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: Temporomandibular disorders (TMD) comprise a cluster of conditions with a wide range of etiological factors that causes pain and discomfort in the masticatory muscles (TMD-M) and temporomandibular joints (TMD-J). More than 50% of the patients with TMD report regular usage of drugs. However, there is still no consensus, nor is there any evidence-based support for clinicians when choosing between different drugs. Therefore, this systematic review, including a network meta-analysis (NMA), aimed to evaluate the scientific evidence and discuss the pharmacological treatment options available to treat painful TMD.METHOD: An electronic search was undertaken to identify randomized controlled trials (RCTs) investigating pharmacological treatments for TMD-M and/or TMD-J, published until 6 April 2023. Since only 11 articles could be used for an NMA regarding TMD-M, a narrative synthesis was also performed for all 40 included RCTs. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias, while the certainty of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS: When it comes to TMD-M, evidence arises for wet needling therapies with BTX-A, granisetron, and PRP as well as muscle relaxants. For TMD-J, evidence points toward pharmacological treatment approaches including non-steroidal antiinflammatory drugs (NSAIDs) and glucocorticosteriods (for inflammatory conditions) as well as hyaluronic acid and dextrose.CONCLUSIONS: The evidence clearly indicates that the pharmacological treatment approaches differ between TMD-M and TMD-J. Therefore, it is of great importance to first try to uncover each patient's individual and multifactorial etiology and then employ a multifaceted treatment strategy, including pharmacological treatment approaches.
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| 4. |
- Christidis, Nikolaos, et al.
(författare)
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Psychological treatments for temporomandibular disorder pain—A systematic review
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842. ; 51:7, s. 1320-1336
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Forskningsöversikt (refereegranskat)abstract
- Objective: Temporomandibular disorders (TMD) are common. They affect abilities for carrying out daily tasks and influence different psychological aspects. In addition to standard treatment, psychological treatments have been suggested. The aim was to investigate the effects of psychological treatments on patients with painful TMD in a short- and long-term perspective.Materials and Methods: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL), and Web of Science for randomized clinical trials (RCTs) reporting psychological interventions for TMD. Registered beforehand in PROSPERO (CRD42022320106). In total, 18 RCTs were included; six RCTs that could be used in the meta-analysis, and all 18 RCTs were used in the narrative synthesis. Risk of bias was assessed by the Cochrane's tool for assessing risk of bias and certainty of evidence by GRADE.Results: The narrative synthesis indicates that psychological treatment options seem equivalent to standard treatment for painful TMD. The meta-analysis showed that a combination of psychological treatment and standard treatment and manual treatment (very low-quality evidence) are significantly better in pain reduction than just counselling and standard treatments of TMD.Conclusion:This study indicates that psychological treatments seem to reduce pain intensity in individuals with painful TMD, and that the effect seems to be equally good as standard treatment. However, a combination of psychological treatments and standard treatments seems to have an even better effect. This indicates that psychological treatments are promising as an additional treatment approach for painful TMDs.
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| 5. |
- Christidis, Nikolaos, et al.
(författare)
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Swedish dental students’ clinical notes and reflections as part of a case-based examination – challenges for undergraduate education
- 2023
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Ingår i: Medical Research Archives. - : European Society of Medicine. - 2375-1916 .- 2375-1924. ; 11:10
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Tidskriftsartikel (refereegranskat)abstract
- Clinical records are the basis for clinical reasoning, diagnostics, treatment planning, and management as well as for management of the patient and the outcome of the treatment, and therefore an important aspect of health professionals’ work. Several articles emphasize the importance of adequate and correct content in these records. Previous research shows that even health professionals need to improve the content and structure of their clinical records, for them to give the information needed for various needs. The focus of this article are the clinical records of undergraduate dental students. The aim of the study was to explore patterns of adequate and inadequate content in clinical notes of undergraduate dental students in their final year of education. Secondly, whether these results could provide insights for development of health professions education.Data comprised of 33 cased-based examinations collected during January 2020 at the University Dental Clinic, Department of Dental Medicine, Karolinska Institutet, in Huddinge Sweden. Also, data included teachers’ assessment of these examinations. The texts were analyzed with thematic analysis.Analytical results showed three themes. The first theme, (i) Professional content knowledge, concerned information in patient history, status, diagnostics and treatment plan, and an information ambiguity. The theme also included the students' use of professional terminology and the choice of articles to support reflections. The second theme (ii) incomplete method of investigation involved the actual patient interview, but also students’ various misunderstandings of the template. The third theme was (iii) Academic formalities. This theme concerned students' understanding of the purpose of referencing and its function, but also a non-use of references, the use of irrelevant references, errors in the given citation style, and an incorrect structure of the text according to the template. In conclusion, results showed the need for continuous training in clinical note-taking and reflections during dental students' professional education. In this training, teachers’ assessment is important for students' development of professional literacy and professional judgment. Also, a continuous reminder of science and proven experience as the basis for the profession which is also made visible through academic formalities.
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| 6. |
- De la Torre Canales, Giancarlo, et al.
(författare)
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Botulinum toxin-a for the treatment of myogenous temporomandibular disorders : an umbrella review of systematic reviews
- 2024
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Ingår i: Drugs. - : Adis. - 0012-6667 .- 1179-1950. ; 84:7, s. 779-809
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Forskningsöversikt (refereegranskat)abstract
- Objective: 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 the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs.Method: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included.Results: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments.Conclusion: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.
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| 7. |
- Ho, Yuh-Shan, et al.
(författare)
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Research focuses and trends in literacy within education : A bibliometric analysis
- 2023
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Ingår i: Cogent Education. - : Taylor & Francis. - 2331-186X. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to conduct a bibliometric analysis including citation performance in the research topic of literacy within education, by using an innovative method including details of article title, author keyword, KeyWords Plus, and abstracts. This novel study is to our knowledge, the first of its kind within the field of literacy and can therefore provide valuable insights for professionals and others interested in literacy in terms of who and what to read, and where to focus. Data were retrieved 17 December 202217 December 2022 from the Social Sciences Citation Index (SSCI) of Clarivate Analytics for studies published from 1992 to 2021. To evaluate research trends, the distribution of keywords in the article title and author‑selected keywords was used. The search yielded 539 documents in SSCI, of which 489 were document-type “articles”. These articles were published in 142 journals. The analysis of the articles showed that “academic writing,” “higher education,” “writing,” and “assessment” are the most used keywords by the authors. The most frequently cited study was published in 1998 by Lea and Street. Most articles were published in English and originated in the USA and the UK. Most studies in the field of professional literacy are produced in the USA and UK, that is, countries with a long tradition of research in professional education and having English as the main language. Most publications are single-country productions because literacy, to a high extent, are local in nature.
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| 8. |
- Lindberg, Viveca, 1954-, et al.
(författare)
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Characteristics of dental note taking : a material based themed analysis of Swedish dental students
- 2020
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: The transition from upper secondary to higher education and from higher education to professional practice requires that students adapt to new literacy practices, academic and professional. However, there is a gap of knowledge regarding literacy practices in dental education. Therefore, the aim of this study was to identify what characterizes dental students’ notetaking and secondarily to determine what dental students express regarding their notetaking.Methods: To analyze students’ perspectives about the purposes of notetaking and to examine their written notes in depth, three volunteer students, out of the 24 students that voluntarily and anonymously handed in their notes, were interviewed. The three undergraduate dental students that participated in this material-based, semi-structured interview study, framed within a New Literacy Studies approach, were on their third year (6th semester). The focus of these material-based interviews was on each student’s notes. Questions prepared for semi-structured interviews were open-ended and allowed for individual follow-up questions related to the interviewee’s answer. To analyze the outcome of the interviews a thematic analysis was used.Results: From the material-based interviews eight themes that relate to what, how and for what purpose students write were discerned. These eight themes include professional vocabulary, core content as well as clinical examples that belong to what students read and write; multimodal accentuation as well as synthesis that belong to how students read and write; and mnemonic strategies, academic purposes, and professional purposes that belong to for what purpose students read and write.Conclusions: Findings from the interviews indicate that the digital development, offering a variety of available tools, has expanded the notion of notetaking. This study identified that dental students’ notetaking has changed during their education from initially being synchronous, to also include multimodal and asynchronous writing, making notetaking more of a writing practice. Further, students’ writing practices seem to be motivated by their knowledge formation in relation to a subject matter, but also in relation to their experiences during clinical training. Although, our hypothesis was that the main purpose of notetaking and writing was to pass their course examinations, this study showed that students that were half-way through their dental education, are aware that literacy practices are for learning for their future profession, and not only for passing their exams.
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| 9. |
- Lindberg, Viveca, 1954-, et al.
(författare)
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Higher education for professional and/or academic literacy?
- 2019
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Konferensbidrag (refereegranskat)abstract
- As in other professional programmes within academia, part of the learning outcomes relates to content like anatomy and physiology, others relate to tools, and materials used for dental work and their properties – in everyday terminology the ‘theoretical’ aspects of dental work. Other learning outcomes relate to what a dentist does – the ‘practical’ (clinical) aspects of dental knowledge. Aspects of these are both understanding patient needs, hands-on-skills, being able to construct an anamnesis and explain oral conditions, treatment need and prognosis (Kurz, Draper & Silverman, 2016). Furthermore, as becoming a dentist requires attending an educational programme, reading and writing, i.e. literacy competences, are seen as self-evident aspects of contemporary education. While it seems obvious that it takes time to become a skilled dentist and a degree is the necessary beginning in this direction, it seems less obvious that it also takes time to become a skilled writer in academia. But future dentists not only examine or repair their clients’ teeth. Part of a dentist’s everyday work is also to document examinations and treatment, prescribe medicines, but also to communicate with other professionals about clients that may need complementary or specialist treatment. Transition from higher education to work requires that students can cope also with the literacy practices of the profession. Studies with this focus show that although a person may be a successful student, (s)he isn’t necessarily well acquainted with the kinds of literacy demands that (s)he will encounter when entering the world of work (Ask, 2017; Dias et al., 1999). Since the 1980s there has been a growing interest in literacy practices, that is, what people read and write in specific activities, how people are expected to read and write (what qualifies as an acceptable text) and for what purposes representatives for the activity read and write. Our focus is on literacy practices in professional higher education, since these prepare for professional as well as for academic writing. On the one hand, students in professional higher education write as part of their studies, but part of professional higher education there also is a practicum or clinical part (what this part is called varies between programmes). During this part students also write, but the purpose for writing is not necessarily the same.The issue for this paper is firstly, to analyse one of the Swedish dental programmes in relation to its design in relation to possible content of relevance for academic and professional literacy, and secondly to explore the literacy practices of the first two modules of a course, specifically from the perspective of students: what do they read and write, how do they read the texts related to this module, how do they write, and what purposes do they express for their reading and writing?In Sweden previous research concerns professional education for engineers (Hållsten, 2008; Berthén, Eriksson & Lindberg, 2006), teachers (Ask, 2007; Blåsjö 2007) and policemen (Ask, 2014). Furthermore, the academic literacy has been studied by Blåsjö (2004) and (Hagström 2005). Our study aligns with the theoretical framings for such studies – text-cultures (Bazerman, 1995), the New Literacy Tradition (NLS) (Street, 2003) with specific focus on literacy in higher education (Jones, Turner & Street, 1999; Lea & Street, 1998, 2006) as well as literacy at work (Barton, Hamilton & Ivanič, 2000). Activity theory has also been used by e.g. Dias and Freedman (1999) in relation to professional higher education and corresponding work (see also Engeström, 1998).Methods/methodologyIn line with studies framed by NLS, ethnographic mapping of literacy events - what students read or wrote, and text-related communication (Barton 2007; Karlsson 2006; Street 2003) informed the data produced. They comprise of the following:Formal documents: the curriculum for the study programme in dentistry as well as the curriculum for the modules Orofacial pan and jaw function 1 and 2 Course literature (recommended however not compulsory): Jeffrey P Okeson (Ed.) (2013). Management of temporomandibular disorders and occlusion. 7th Ed. St. Louis: Mosby. The book is on 488 pages (of which approx. 100 pages consist of references). Of the 68 students, 16 bought the book. Teaching material: hand-outs (copies of lecturers’ power-points) to students. Power-points for all lectures are based on core content from the book. Students' notes (N=10), all anonymised. In total, 68 students attended the modules. The group pf students was informed about the study and or interest in having copies of their notes but that participation was voluntary.Audio-recordings of the lectures (N=8) – permission given by the two teachers – with the microphone placed close to the teacher. The audio-recordings were complemented by field-notes from one or two researchers attending each lectureMultiple-choice tests and students’ results (although not used for this paper).Complementary to the multiple-choice test there were three mandatory clinical skills demonstrations. For the clinical skills demonstration, no documentation was demanded of the students. The teacher filled in a template for each student, based on observation of students’ performances.Video-recorded, material based thematic interviews with students. During one of the final lectures, students were asked if they could consider being interviewed based on their notes from the lectures. All three student that registered were interviewed. The video recording focused only on students’ notes and their hands, the main point with this procedure was to capture if and when a student pointed at some specific part of their notes.Data was processed and analysed in the following steps: The formal documents were read in order to identify parts of the programme and curricula were academic and/or professional literacy was likely to occur. For this part, the dental researchers in the group necessary. Secondly, the teaching material provided by the two teachers (hand-outs of their Power-point presentations) were compared to students’ notes in order to identify what kinds of notes students made. Thirdly, the interviews with students about their were analysed (this part is still in progress).Expected outcomes/preliminary results/implications The analysis of the programme showed that there, in principle, are several options for addressing both academic and professional literacy. During the first semester the curriculum indicates that students are expected to read academic articles. Attention should be paid both to the content and the structures of these articles. During the following semesters, professional literacy is focused in terms of communication with clients, colleagues and teams of various professions, but also written documentation for various professional purposes. From the sixth semester, academic writing is introduced. In parallel, more complex professional communication and documentation becomes part of the curriculum.The analysis of students’ notes was performed by two researchers, one specialized in dentistry and the other in pedagogy, for reasons of double-control. Both researchers had participated in data collection and observation of lectures. This analysis was developed and tried out based on randomly selected notes from one student before the main analysis of all student texts. The initial analytical template of the student texts was then compared to the main analysis, and the congruency was satisfactory. We found that some students took notes in hand-writing, while others took digital notes. In relation to what was noted, we found three types of notes: 1) copied text from teachers’ power-points, 2) re-formulated text in teachers’ power-points, and 3) written complementing text. The amount of each type pf notes was then estimated and patterns of the three types of notes (copied, re-formulated, or complementary) for each student were mapped and patterns were then constructed into profiles for students’ note-taking. The result of this analysis was used for developing some of the questions for the thematic interviews with students. Preliminary findings of the interviews show that students are aware of professional as well as of academic writing throughout the programme.
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| 10. |
- Lindberg, Viveca, 1954-, et al.
(författare)
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Literacy as part of professional knowing in a Swedish dental education
- 2021
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Academic reading and writing are seen as self-evident literacy competences in most contemporary higher educations, however, whether students also are introduced to professional literacy of relevance for dentistry during their education is a question. The purpose of this study is to analyze one of the Swedish dental programmes, with respect to its design, in relation to possible content of relevance for academic and professional literacy. Secondarily, to identify and analyze Swedish dental students’ writing in an academic setting, i.e. what these students are expected to read and write, and how they write.Methods: Data, for this ethnographically inspired case-study, was produced by observations and audio-recordings of lectures, copies of teachers’ handouts and of volunteering students’ notes, and a multiple-choice-test. Dataanalysis was made in five steps, starting with macro-level data, i.e. curriculum and syllabuses, followed by the syllabuses for the two observed modules, the teacher-provided material, analysis of the students’ notes, while in the fifth and final step, the results from the previous steps were compared, to find patterns of what students were expected to read and write, and what in the teacher-provided multimodal material that was emphasized in teachers’ talk.Results: This study showed that students were engaged in several types of literacy events, such as reading, finding and watching videos on their learning platform, writing, and following instructions. The study also showed that there is a recurrent academic content comprised of anatomy, physiology and pathology, while the professional content comprised of patient communication and anamnesis. Further, an integrated content was found and was initiated in teacher-constructed PowerPoints and by student-questions. Note-taking patterns varied between individual students, but the general pattern for this group of students were the use of complementary notes. This type of note-taking was used to make available further descriptions of the teacher-constructed text in PowerPoints, but also an independent text describing pictures shown on teachers’ PowerPoints or the blackboard.Conclusion: Findings from the present study reveal that students either copy text from teachers’ PowerPoint-slides, re-formulate text from teachers’ PowerPoint-slides, or write complementing text to teachers’ PowerPoint-slides. Further, the students individually choses type of note-taking based on situation. The study also revealed that the academic literacy – in the two modules during the fifth and sixth semesters of a dental education analyzed – mainly has a professional basis for reading, writing, and communication purposes. The study also showed that academic and professional literacy are closely connected through recurrent integration.
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| 11. |
- Lindberg, Viveca, 1954-, et al.
(författare)
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Literacy as Part of Professional Knowing in Dental Education
- 2018
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Konferensbidrag (refereegranskat)abstract
- The issue of this paper to scrutinise Swedish dental students’ writing in academic setting: what these students are expected to read and write, how they are expected to do this, and for what purposes they read and write.Dental education is one of several professional programmes in higher education. The national learning outcomes stated in the Higher Education Ordinance (SFS 1993:100- SFS 2017:284) point out for example the importance of knowledge of the scientific basis as well as of proven experience for dental work, the capability of making diagnoses aw well as treating various dental diseases and malformations, but also leadership and collaboration. Such learning outcomes obviously are abstract, as they coven a whole program of 300 ECTS, and are to be somewhat more concretized in syllabuses for the various courses that together form the programme. However, as in other professional programmes within academia, part of the learning outcomes relate to content like physiology and neurology, others relate to tools, and materials used for dental work and their properties – in everyday terminology the ‘theoretical’ aspects of dental work. Other learning outcomes relate to what a dentist does – the ‘practical’ (clinical) aspects of dental knowledge. Furthermore, as becoming a dentist requires attending an educational programme, reading and writing are seen as self-evident aspects of the education. While it seems obvious that it takes time to become a skilled dentist and a degree is the necessary beginning in this direction, it seems less obvious that it also takes time to become a skilled writer in academia – where the meaning of being a skilled writer varies between disciplines (Bazerman, 1995; Blåsjö, 2004; Hjalmarsson et al. 2017; Lea & Street 1998; Airey 2011). Being a student in any higher education assumes participating in an activity that to a large extent is literacy based. To have the literacy competences and strategies needed for educational activities are crucial resources for students – these are the means for coping with literacy demands in varying but relevant situations, depending on the purpose of reading and or writing (Bazerman 1995; Dias et al. 1999; Berthén et al. 2006; Street, 2003). For students in professional programmes, there is also another aspect – today part of a dentist professional work is literacy-related: documentation of work done, reports, subscriptions, referrals – these are one type of examples of what dentists are expected to write as part of their work. Other types of writing that today are imposed on most professions, be they academic or not, are related to quality control, sustainability and security (Lindberg, 2003). Previous studies show that the transition from upper secondary school to higher education is challenging for students (Ask 2007), since the literacy practices they have experiences of differ from those they encounter in academia. Appropriating relevant academic literacies is relational – i.e. students of course need to struggle but it is also a question of what is made available to them (Edwards 2005). Characteristic for of academic literacies, whether in science (Airey 2011); engineering (Berthén et al. 2006; Hållsten 2008); in history or national economy (Blåsjö 2004), is that students nee to master different genres (a breadth), but also a progression, in terms of complexity, in order to become successful within a programme or a discipline. So the overarching question for this paper is what literacy practices that characterise one of the Swedish dental programmes? MethodThe present study is conducted during the third year of the study programme in dentistry (SPD), during the modules “orofacial pain and jaw function 1 and 2”, at the Department of Dental Medicine, Karolinska Institutet, Sweden. The SPD has a duration of five years (300 credits) divided into 10 semesters. Each of the 10 semesters is composed by courses and the courses in modules. The third year consist of the fifth and sixth semesters. The modules “orofacial pain and jaw function 1 and 2” are closely connected with each other and are divided into two modules due to the semester break. The data analysed for this paper are modules part of the courses ”clinical odontology 2 and 3. For the overall project, the data produced are of three types: (i) curricular documents, including information given in study guides to the students; (ii) ethnographic data from lectures and clinical work (sound-recordings and field-notes during lectures, textbooks, hand-outs from the lectures, student notes from the given lectures, multiple-choice questions from the digital examination and clinical instructions); as well as (iii) interviews with students and teachers. Literacy events, i.e. what students read or write, and text-related communication (Barton 2007; Karlsson 2006; Street 2003) are mapped throughout all activities (lectures, clinical work, and examinations). During clinical work, only field-notes were taken and only one of the researchers that also were teachers in the programme took the notes since clinical work also involves patients. As a first step of the analysis, we use literacy event for identifying patterns related to text genres (Barton 2007; Street, 2003), and will pay attention to multimodal aspects (Airey 2011; Kress 2003) of text used and produced. The second step is to analyse relations between patterns, i.e. questions like What literacy practices characterize dental education? Which of these patterns are related to dental academic literacy practices, and which are related to professional dental literacy practices? Since data produced so far are from the first phase of the project, this is how far we have come.Expected OutcomesAs some of the data production will continue during spring, we have so far concentrated on the mapping of literacy events (step 1 in the analysis), which mainly is a descriptive result. During lectures, powerpoints were used for structuring the physiological knowledge related to orofacial pain and jaw function. All slides were distributed in advance to the students via the digital learning environment used by KI. Most slides were multimodal in that they combined graphical pictures of neurological and physiological information related to the construction of a jaw and the different functions of the parts, highlighting aspects specifically related to orofacial pain. Students’ notes vary: while some made notes directly in the powerpoint, others took notes separately. During clinical work, students were given forms to fill in with the purpose of two types of documentation: medical and narrative. The analytic result will complement this descriptive result.
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| 12. |
- Al-Khotani, Amal A, et al.
(författare)
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Professional knowledge among Swedish and Saudi healthcare practitioners regarding oro-facial pain in children and adolescents
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Oro-facial pain (OFP) and temporomandibular disorders (TMD) in children and adolescents are a growing problem. To meet patients' healthcare needs, professionals must perform their work intuitively and with quality. Therefore, a high degree of professional knowledge is necessary. To investigate the professional knowledge regarding OFP/TMD in children and adolescents among Swedish and Saudi Arabian dental and medical specialists compared with Swedish OFP specialists. One questionnaire including the four domains Chronic pain and behaviour; Aetiology; Diagnosis and classification; Treatment and prognosis was distributed to 383 potential participants, that is physicians and dentists in Sweden and Saudi Arabia. The Swedish OFP/TMD specialists were used as a reference group. The response rates from Sweden and Saudi Arabia were 49% and 86%, respectively. The degree of agreement was highest in the domain Chronic pain and behaviour, especially for the Swedish groups. Regarding the other three domains, the agreement was modest to poor. In general, Swedish groups showed a higher agreement with Swedish OFP/TMD specialists than Saudi Arabian groups. This study shows that professional knowledge regarding OFP/TMD in children and adolescents is limited among Swedish and Saudi Arabian dental and medical professionals compared to Swedish OFP/TMD specialists. In Swedish groups, the professional knowledge is more accurate than in the corresponding Saudi Arabian. With these results in mind, and the frequent prevalence of OFP/TMD in children and adolescents, one can draw the conclusion that there is a need for modern medical education regarding OFP/TMD among both physicians and dentists, especially in Saudi Arabia.
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| 13. |
- Al-Khotani, Amal, et al.
(författare)
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Study on self-assessment regarding knowledge of temporomandibular disorders in children/adolescents by Swedish and Saudi Arabian dentists
- 2015
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 73:7, s. 522-529
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To estimate the degree of self-assessed knowledge among dentists in Sweden and Saudi Arabia regarding temporomandibular disorders (TMD) in children and adolescents using a summative form of assessment and further to investigate the possible factors that may influence the self-assessed knowledge. MATERIALS AND METHODS: A questionnaire survey covering four domains (Etiology; Diagnosis and classification; Chronic pain and pain behavior; Treatment and prognosis) regarding TMD knowledge was used. Out of 250 questionnaires (125 in each country) a total of 65 (52%) were returned in Sweden and 104 (83%) in Saudi Arabia. RESULTS: Self-assessed individual knowledge was significantly associated to the level of actual knowledge among the Swedish groups in the domains Etiology; Diagnosis and classification and Treatment and prognosis (p < 0.05). However, in the Saudi Arabian groups a corresponding significant association was only found in the domain Diagnosis and classification (p < 0.05). CONCLUSIONS: This study showed that there is a difference in the accuracy of self-assessment of own knowledge between the dentists in Sweden and Saudi Arabia. The Swedish dentists have a better ability to assess their level of knowledge compared to Saudi Arabian dentists regarding TMD in children and adolescents. This difference could be related to several factors such as motivation, positive feedback, reflection, psychomotor, and interpersonal skills, which all are more dominant in the Swedish educational tradition.
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| 14. |
- Christidis, Nikolaos, et al.
(författare)
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Comparison of the Levels of Pro-Inflammatory Cytokines Released in the Vastus Lateralis Muscle of Patients with Fibromyalgia and Healthy Controls during Contractions of the Quadriceps Muscle – A Microdialysis Study
- 2015
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Fibromyalgia is associated with central hyperexcitability, but it is suggested that peripheral input is important to maintain central hyperexcitability. The primary aim was to investigate the levels of pro-inflammatory cytokines released in the vastus lateralis muscle during repetitive dynamic contractions of the quadriceps muscle in patients with fibromyalgia and healthy controls. Secondarily, to investigate if the levels of pro-inflammatory cytokines were correlated with pain or fatigue during these repetitive dynamic contractions. MATERIAL AND METHODS: 32 women with fibromyalgia and 32 healthy women (controls) participated in a 4 hour microdialysis session, to sample IL-1β, IL-6, IL-8, and TNF from the most painful point of the vastus lateralis muscle before, during and after 20 minutes of repeated dynamic contractions. Pain (visual analogue scale; 0-100) and fatigue Borg's Rating of Perceived Exertion Scale; 6-20) were assessed before and during the entire microdialysis session. RESULTS: The repetitive dynamic contractions increased pain in the patients with fibromyalgia (P < .001) and induced fatigue in both groups (P < .001). Perceived fatigue was significantly higher among patients with fibromyalgia than controls (P < .001). The levels of IL-1β did not change during contractions in either group. The levels of TNF did not change during contractions in patients with fibromyalgia, but increased in controls (P < .001) and were significantly higher compared to patients with fibromyalgia (P = .033). The levels of IL-6 and IL-8 increased in both groups alike during and after contractions (P's < .001). There were no correlations between pain or fatigue and cytokine levels after contractions. CONCLUSION: There were no differences between patients with fibromyalgia and controls in release of pro-inflammatory cytokines, and no correlations between levels of pro-inflammatory cytokines and pain or fatigue. Thus, this study indicates that IL-1β, IL-6, IL-8, and TNF do not seem to play an important role in maintenance of muscle pain in fibromyalgia.
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| 15. |
- Christidis, Nikolaos
(författare)
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The serotonin receptor type 3 in chronic and experimental human muscle pain
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main aim of this thesis was to gain a better understanding of the influence of serotonin on chronic craniofacial muscle pain. The thesis comprised a basic science part and a human experimental part. The aim for the basic science part was to investigate if the expression of 5-HT3 receptors in muscle tissue differ between myalgic and healthy muscles and if sex or muscle site influence this expression. The aim for the human experimental part was to investigate if the specific 5-HT3 antagonist granisetron influences pain variables in patients with chronic craniofacial myalgia and experimental pain induced by hypertonic saline, as well as the mechanical pain threshold of healthy muscles. A second aim was to investigate if any effect by granisetron was influenced by sex, muscle site or route of administration, i.e. local or systemic. In the basic science part, patients with chronic local myalgia of the masseter muscle and age- and sexmatched healthy controls were examined clinically according to the Research Diagnostic Criteria for Temporomandibular Disorders. Traditional biopsies were taken intra-orally with a 4-mm Bergström needle from the most painful part of the masseter muscle in patients, and from a standardized point in the healthy controls. In order to compare if there were any differences in receptor expression due to sex or between muscles a microbiopsy technique was used to obtain masseter muscle and tibialis anterior muscle biopsies in healthy age-matched men and women. The patients were found to have a significantly higher amount of co-expressed 5-HT3A receptors and NaV1.8 sodium channels in the connective tissue compared to their healthy controls. This novel finding makes it presumable that in myalgic muscles proliferation of nociceptive nerve fibers occurs in the connective tissue surrounding the myocytes. Further, in healthy subjects, the co-expression of 5-HT3A receptors and NaV1.8 sodium channels in the masseter muscle was higher in women than in men. The tibialis anterior muscle expressed more 5-HT3A receptors than the masseter muscle. However, since these fibers did not co-express NaV1.8 sodium channels extensively, they are presumed being motor neurons. The first experimental part, investigating the effect of granisetron on the mechanical pain threshold, comprised both healthy men and age-matched women. Granisetron was administrated in a randomized, placebo-controlled and double-blind manner both systemically and locally by intramuscular injection. Sugar pills and isotonic saline served as placebo. The pressure pain threshold (PPT) was examined over the masseter, temporalis anterior, trapezius and tibialis anterior muscles before and after drug administration. The PPT of the masseter muscle increased significantly after local administration of granisetron and for all muscles combined after systemic administration. However, the increase of PPT was only significant over the trapezius and tibialis anterior muscles. Further, the PPT at baseline was significantly higher in the men and the increase of PPT after administration of granisetron was also only significant in the men. This blockage of the 5-HT3 receptors with granisetron seems to inhibit serotonin to excite and sensitize nociceptors, leading to a reduced sensitivity to mechanical stimuli. The second experimental part used a randomized, placebo-controlled and double-blind methodology to investigate how granisetron influences masseter muscle pain variables both in patients with chronic local myalgia, and in an experimental pain situation including sex- and age-matched healthy individuals. In the experimental pain situation injections with hypertonic saline were used to induce pain, followed by injections of granisetron or placebo as pre-treatment before a second pain induction with hypertonic saline. Granisetron significantly reduced both clinical and experimentally induced pain variables. The painful area was greater in the healthy women compared to the men before pre-treatment with granisetron. However, after pre-treatment with granisetron there were no significant sex differences in any pain variable. These findings indicate that 5-HT3 receptors play a significant role in pain transmission and pain modulation in human muscles, since granisetron diminishes experimentally hypertonic saline-induced pain and chronic myalgia of the masseter muscle. Conclusively, our novel findings that the 5-HT3 receptor is up-regulated in painful craniofacial muscles and that blocking of this receptor decreases clinical and experimental human muscle pain indicate that the 5-HT3 receptor has an important role in peripheral pain transmission in localized chronic muscle pain.
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| 16. |
- Collin, Malin, et al.
(författare)
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Salivary biomarkers in children with juvenile idiopathic arthritis and healthy age-matched controls : a prospective observational study.
- 2022
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- 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 saliva in children with juvenile idiopathic arthritis (JIA) as well as saliva flow and the influence of orofacial pain on saliva flow. Of the 60 participants (7-14 years old) enrolled, 30 had a diagnosis of JIA and active disease, and 30 were sex- and age-matched healthy controls. Demographic data and three validated questions regarding presence of orofacial pain and dysfunction were recorded. Stimulated whole saliva was collected and analyzed using a customized R&D bead-based immunoassay with 21 targeted biomarkers. Fourteen of these were detectable and showed similar levels in both children with JIA and controls: TNF-alpha, TNFRSF1B, MMP-2, MMP-3, IL-1alpha, IL-1beta, IL-6R alpha, IL-8, S100A8, CCL2, CCL3, IL-10, CCL11, and CXCL9. In addition, there was no difference in salivary flow rate between groups, but there was an association between orofacial pain and reduced saliva flow rate for both groups.Trial registration: ClinicalTrials.gov Protocol id: 2010/2089-31/2.
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| 17. |
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| 18. |
- Jounger, Sofia Louca, et al.
(författare)
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Influence of Polymorphisms in the HTR3A and HTR3B Genes on Experimental Pain and the Effect of the 5-HT3 Antagonist Granisetron
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- 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 injections (HS, 5.5%, 0.2 mL) into the masseter muscles. Thirty min later the masseter muscle on one side was pretreated with 0.5 mL granisetron (1 mg/mL) and on the other side with 0.5 mL placebo (isotonic saline) followed by another HS injection (0.2 mL). Pain intensity, pain duration, pain area and pressure pain thresholds (PPTs) were assessed after each injection. HS evoked moderate pain, with higher intensity in the women (P = 0.023), but had no effect on PPTs. None of the SNPs influenced any pain variable in general, but compared to men, the pain area was larger in women carrying the C/C (HTR3A) (P = 0.015) and pain intensity higher in women with the A/C alleles (HTR3B) (P = 0.019). Pre-treatment with granisetron reduced pain intensity, duration and area to a lesser degree in women (P < 0.05), but the SNPs did not in general influence the efficacy of granisetron. Women carrying the C/T & T/T (HTR3A) genotype had less reduction of pain intensity (P = 0.041) and area (P = 0.005), and women with the C/C genotype (HTR3B) had less reduction of pain intensity (P = 0.030), duration (P = 0.030) and area compared to men (P = 0.017). In conclusion, SNPs did not influence experimental muscle pain or the effect of granisetron on pain variables in general, but there were some sex differences in pain variables that seem to be influenced by genotypes. However, due to the small sample size further research is needed before any firm conclusions can be drawn.
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| 19. |
- Lanefelt, Sarah Vaderlind, et al.
(författare)
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Tooth Clenching Until Exhaustion Evokes Exercise-Induced Hypoalgesia in Healthy Persons and in Patients with Temporomandibular Disorders.
- 2019
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Ingår i: Journal of oral & facial pain and headache. - : Quintessence Publishing. - 2333-0384. ; 33:1
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Tidskriftsartikel (refereegranskat)abstract
- 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) was examined by recording pressure pain thresholds (PPTs) in the masseter (MA) and brachioradialis (BR) muscles during tooth clenching until exhaustion. Pain and fatigue were assessed before and after clenching, and pain amplification was examined by applying a painful mechanical pressure at the MA for 2 minutes while assessing pain every 30 seconds. Analyses of data included repeated measures analysis of variance.RESULTS: In the contracting MA, PPTs increased over time in all three groups (P < .001), while PPTs in the relaxed BR increased only in the men (P = .045). Pain intensity and fatigue in the MA increased after contraction in all groups (P < .003) and was higher in the women with TMD than in the healthy women (P < .001). Only the women with TMD showed pain amplification (P < .001).CONCLUSION: Tooth clenching until exhaustion could activate EIH locally; ie, the magnitude of EIH in the MA was similar in women with TMD myalgia and pain-free women, indicating no deficient EIH in women with TMD. However, only women with TMD showed pain amplification during application of continuous painful pressure.
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| 20. |
- Louca Jounger, Sofia, et al.
(författare)
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Polymorphisms in the HTR2A and HTR3A Genes Contribute to Pain in TMD Myalgia
- 2021
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Ingår i: Frontiers in Oral Health. - : Frontiers Media S.A.. - 2673-4842. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- 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 as stress, anxiety and depression.Materials and Methods: One hundred and seventeen individuals with TMD myalgia were included. A venous blood or saliva sample was taken for genetic analyses and genotyped regarding HTR2A (rs9316233) HTR3A (rs1062613), HTR3B (rs1176744), SERT (5-HTTLPR) and COMT (rs4680). A clinical examination according to Diagnostic Criteria for TMD (DC/TMD) was performed and axis II data (psychosocial factors) were compared between participants with different genotypes for each gene using Kruskall–Wallis test. The characteristic pain intensity (CPI) was tested for correlations to scores for the Perceived Stress Scale, Generalized Anxiety Disorder, and Patient Health Questionnaires using Spearman's rank correlation test with Bonferroni correction for multiple testing. To further explore data factor analysis was performed to identify latent factors associated to the outcome variables.Results: Participants carrying at least one copy of the rare allele of the HTR2A (rs9316233) and HTR3A (rs1062613) had higher CPI compared with the participants with the homozygous common genotype (P = 0.042 and P = 0.024, respectively). Correlation analyses showed several significant positive correlations between CPI on one hand, and self-reported psychosocial distress and jaw function on the other hand for several genotypes that mostly were weak to moderate. The factor analysis identified two latent variables. One was positively correlated to the HTR3B gene, jaw function and self-reported parafunctions, and the other was positively correlated to psychological distress and negatively correlated to SERT.Conclusion: Taken together, the polymorphism rs1062613 in the HTR3A gene contributes to pain intensity in TMD myalgia. This together with positive interactions between pain variables and psychological factors in genotypes strengthens that pain and psychological distress are related. Further research is needed to explore this as well as the influence of gene-to-gene interactions on pain and psychological distress.
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| 21. |
- Louca, Sofia, et al.
(författare)
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Serotonin, glutamate and glycerol are released after the injection of hypertonic saline into human masseter muscles : a microdialysis study
- 2014
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Ingår i: Journal of Headache and Pain. - : Springer. - 1129-2369 .- 1129-2377. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic myalgia is associated with higher muscle levels of certain algesic biomarkers. The aim of this study was to investigate if hypertonic saline-induced jaw myalgia also leads to release of such biomarkers and if there were any sex differences in this respect. METHODS: Healthy participants, 15 men and 15 aged-matched women (25.7 ± 4.3 years) participated. Intramuscular microdialysis into masseter muscles was performed to sample serotonin (5-HT), glutamate, lactate, pyruvate, glucose and glycerol. After 2 hours 0.2 mL hypertonic saline (58.5 mg/mL) was injected into the masseter on one side and 0.2 mL isotonic saline (9 mg/mL) into the contralateral masseter close to the microdialysis catheter. Microdialysis continued for 1 hour after the injections. Pressure pain thresholds (PPT) and pain were assessed before and after injections. RESULTS: The median (IQR) peak pain intensity (0-100 visual analogue scale) after hypertonic saline was 52.5 (38.0) and after isotonic saline 7.5 (24.0) (p < 0.05). 5-HT, glutamate and glycerol increased after hypertonic saline injection (p < 0.05). Lactate, pyruvate and glucose showed no change. PPT after microdialysis was reduced on both sides (p < 0.05) but without side differences. Pain after hypertonic saline injection correlated positively to 5-HT (p < 0.05) and negatively to glycerol (p < 0.05). CONCLUSIONS: 5-HT, glutamate and glycerol increased after a painful hypertonic saline injection into the masseter muscle, but without sex differences. Since increased levels of 5-HT and glutamate have been reported in chronic myalgia, this strengthens the validity of the pain model. Glycerol warrants further investigations.
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| 22. |
- Shimada, Akiko, et al.
(författare)
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Functional Change in Experimental Allodynia After Glutamate-Induced Pain in the Human Masseter Muscle
- 2020
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Ingår i: FRONTIERS IN ORAL HEALTH. - : Frontiers Media S.A.. - 2673-4842. ; 1
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Tidskriftsartikel (refereegranskat)abstract
- 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-inducedmassetermuscle pain and NGF-induced allodynia on pain perception and jaw function in healthy individuals, and any possible sex differences in the response. Materials and Methods: Thirty pain-free adult participants (15 men and 15 women, mean age +/- SD: 24 +/- 4 years) participated in this study consisting of three sessions (Day 0, Day 3, and Day 4). NGF (5 mu g/mL, 1.0mL) was injected into the masseter muscle on Day 0 to induce muscle allodynia. On Day 3, glutamate (1M, 0.2mL) was injected into the same masseter muscle. Before and after injections on Day 0 and 3, and post-injection (Day 4), spontaneous pain, temporal summation pain, as well as functional pain and fatigue in response to chewing were assessed with validated scales, and the pressure pain threshold (PPT) was recorded. Results: Spontaneous pain intensity was significantly higher after glutamate than NGF (P < 0.001). PPTs, temporal summation pain and functional measures were all reduced 3 days after NGF injection (P's < 0.001). Injection of glutamate on Day 3 did not further affect PPTs or temporal summation pain and there were no sex differences in the effects (P > 0.189). Chewing pain (P = 0.022) and fatigue increased after glutamate injection to a higher degree in the women than men (P = 0.037). Conclusion: Taken together, while glutamate injected into the NGF-sensitized muscle was painful, it did not alter muscle tenderness in women vs. men. However, pain and fatigue evoked by jaw function were higher in women after glutamate injection. This suggest that sex differences reported for masseter myalgia, mimicked by glutamate and NGF mediated pain in this study, may be greater for measures of perceived jaw function, which should be considered in a clinical evaluation.
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| 23. |
- Yekkalam, Negin, et al.
(författare)
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Could Reported Sex Differences in Hypertonic Saline-induced Muscle Pain be a dose Issue?
- 2019
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Ingår i: Dental Oral Biology and Cranofacial Research. - 2613-4950. ; 2:5, s. 3-8
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Tidskriftsartikel (refereegranskat)abstract
- Higher levels of experimental muscle pain induced by injection of the same volume of noxious substances have been reported by women compared to men. This could hypothetically be related to the difference in muscle volume between men and women. The aim of this study was to investigate if the sex differences reported by intramuscular injection of hypertonic saline would disappear if a larger dose is given to men than women under similar conditions.Methods: Fifty-six healthy volunteers (25 men and 31 women) received hypertonic saline injection into the masseter muscle, 0.5 mL for men and 0.3 mL for women, to evoke pain. Pain intensity was assessed with 0-100 mm visual analogue scale (VAS) every 15 seconds until pain subsided or maximum 300s. VAS was also used to assess perceived unpleasantness and anxiety. Pain drawings were used to assess maximal pain distribution, and the McGill pain questionnaire to assess pain quality.Results: There was no sex difference in maximum pain intensity, unpleasantness, anxiety or pain drawing area, but the evoked pain had larger total pain area (p=0.005), and longer duration (p<0.001) in the men than women. The sexes also used some different pain descriptors.Conclusions: This study shows that the previously reported higher pain levels in women were abolished when a lower dose of hypertonic saline was injected into the masseter muscle of the women than men. This might indicate that the sex differences reported to hypertonic-induced muscle pain may be a dose issue. Further studies are required to validate these results
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