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Post-exertional malaise
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=== An illness within an illness === PEM refers to a worsening of many ME/CFS symptoms as a result of physical or mental exertion. It consists of more than post-exertional fatigue and pain, and can cause severe debility.<ref name="Stussman2020" /> As one patient described it: <blockquote>"When I do any activity that goes beyond what I can do—I literally collapse—my body is in major pain, it hurts to lay in bed, it hurts to think, I can’t hardly talk—I can't find the words, I feel my insides are at war."<ref name="IOM2015" /></blockquote> Another patient emphasized that the feeling of PEM is very different from what one experiences as a healthy person: <blockquote>"PEM is like nothing else you will experience in healthy life; a combination of a hangover, the flu, finishing a 10k run, all at the same time at varying levels of severity."<ref>{{Cite news | url=https://twitter.com/Fatigo_MECFS/status/1050305665565102080 | title = Fatigo_MECFS on Twitter|work=Twitter|access-date=2018-10-11|language=en}}</ref></blockquote>Considering the serious but fluctuating debility PEM causes, ME/CFS expert Dr. [[Anthony Komaroff]] described it as "an illness within an illness".<ref>{{Cite news | url=https://phoenixrising.me/archives/11884 | title = Post-Exertional Malaise II: Perception and Reality By Jennifer M. Spotila, J.D. | last=Spotila | first=Jennifer | author-link = Jennifer Spotila|work=Phoenix Rising|access-date=2018-10-10|language=en-US}}</ref>
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