Post-exertional malaise: Difference between revisions

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'''Post-exertional malaise''' (PEM) is a worsening of many [[ME/CFS]] symptoms as a result of physical or mental exertion.  Patients, ME/CFS organizatons, clinicians and researchers that work in the ME/CFS field often referred to it as "the marker," i.e., the main symptom that differentiates [[ME]] and [[CFS]] from other fatiguing illnesses. PEM can last for days to weeks after the exertion.<ref name="JohnsonCsymptoms" /><ref name="FightFatiguePEM" />
'''Post-exertional malaise''' (PEM) is a worsening of many [[ME/CFS]] symptoms as a result of physical or mental exertion.  Patients, ME/CFS organizatons, clinicians and researchers that work in the ME/CFS field often referred to it as "the marker," i.e., the main symptom that differentiates [[ME]] and [[CFS]] from other fatiguing illnesses. PEM can last for days to weeks after the exertion.<ref name="JohnsonCsymptoms" /><ref name="FightFatiguePEM" />


Worsening symptoms include [[chronic fatigue]], flu-like symptoms, brain fog ([[cognitive dysfunction]]), [[unrefreshing sleep]], chronic pain, [[orthostatic intolerance]], [[neurally mediated hypotension]], [[POTS]] and more. "As with the severity, the exertion needed to trigger PEM theories case-by-case. For some, it might kick in after a little bit of exercise on top of a day's regular activities. For others, is incredible as it may seem, it can just take a trip to the mailbox, a shower, or sitting upright for an hour."  <ref>[https://www.verywell.com/what-is-post-exertional-malaise-716023 What Is Post-exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[https://www.verywell.com/post-exertional-malaise-715670 Post Exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[http://www.webmd.com/chronic-fatigue-syndrome/chronic-fatigue-syndrome-symptoms Chronic Fatigue Syndrome - Web MD]</ref><ref>[http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf PEM Series - Solve ME/CFS - Jenny Spotila]</ref> Onset of PEM can be delayed 24-72 hours.<ref>[http://www.whathealth.com/awareness/event/internationalcfsmeawarenessday.html What Health - International CFS/ME Awareness Day 2017 - CFIDS Association of America]</ref>
Worsening symptoms include [[Chronic fatigue (symptom)|chronic fatigue]], flu-like symptoms, brain fog ([[cognitive dysfunction]]), [[unrefreshing sleep]], chronic pain, [[orthostatic intolerance]], [[neurally mediated hypotension]], [[POTS]] and more. "As with the severity, the exertion needed to trigger PEM theories case-by-case. For some, it might kick in after a little bit of exercise on top of a day's regular activities. For others, is incredible as it may seem, it can just take a trip to the mailbox, a shower, or sitting upright for an hour."  <ref>[https://www.verywell.com/what-is-post-exertional-malaise-716023 What Is Post-exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[https://www.verywell.com/post-exertional-malaise-715670 Post Exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[http://www.webmd.com/chronic-fatigue-syndrome/chronic-fatigue-syndrome-symptoms Chronic Fatigue Syndrome - Web MD]</ref><ref>[http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf PEM Series - Solve ME/CFS - Jenny Spotila]</ref> Onset of PEM can be delayed 24-72 hours.<ref>[http://www.whathealth.com/awareness/event/internationalcfsmeawarenessday.html What Health - International CFS/ME Awareness Day 2017 - CFIDS Association of America]</ref>


A 2016 DePaul University study focused on deciphering if post-exertional malaise was a generalized, full-body fatigue and/or a muscle-specific fatigue. The results suggested that PEM is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.<ref name="McManimen, 2016" />
A 2016 DePaul University study focused on deciphering if post-exertional malaise was a generalized, full-body fatigue and/or a muscle-specific fatigue. The results suggested that PEM is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.<ref name="McManimen, 2016" />
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==Notable studies==
==Notable studies==
 
*2018, Comparing Post-Exertional Symptoms Following Serial Exercise Tests<ref>Lariel J. Mateo, University of the Pacific, Poster at 2018 Pacific Undergraduate Research and Creativity Conference (PURCC)</ref> [https://scholarlycommons.pacific.edu/purcc/2018/events/87/ (Abstract)]
*2016, Deconstructing post-exertional malaise: An exploratory factor analysis<ref name="McManimen, 2016" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325824/ (Full Text)]
*2016, Deconstructing post-exertional malaise: An exploratory factor analysis<ref name="McManimen, 2016" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325824/ (Full Text)]
*1999, Demonstration of delayed recovery from fatiguing [[exercise]] in [[chronic fatigue syndrome]] [https://www.ncbi.nlm.nih.gov/pubmed/10209352 (Abstract)]
*2013, Post-exertion malaise in [[chronic fatigue syndrome]]: symptoms and gene expression<ref name="MeyerJ2013" /> [[http://www.tandfonline.com/doi/abs/10.1080/21641846.2013.838444 (Abstract)]
*2015, [[Myalgic Encephalomyelitis]]: Symptoms and [[Biomarker]]s<ref name="JasonL2015bio" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761639/#!po=2.51799 (Full Text)]  
*2015, [[Myalgic Encephalomyelitis]]: Symptoms and [[Biomarker]]s<ref name="JasonL2015bio" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761639/#!po=2.51799 (Full Text)]  
*2015, Changes in Gut and Plasma [[Microbiome]] following [[Exercise]] Challenge in [[ME/CFS|Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)]]<ref name="ShuklaS2015" /> [http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0145453 (Full Text)]
*2015, Changes in Gut and Plasma [[Microbiome]] following [[Exercise]] Challenge in [[ME/CFS|Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)]]<ref name="ShuklaS2015" /> [http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0145453 (Full Text)]
*2013, Post-exertion malaise in [[chronic fatigue syndrome]]: symptoms and gene expression<ref name="MeyerJ2013" /> [[http://www.tandfonline.com/doi/abs/10.1080/21641846.2013.838444 (Abstract)]
*1999, Demonstration of delayed recovery from fatiguing [[exercise]] in [[chronic fatigue syndrome]] [https://www.ncbi.nlm.nih.gov/pubmed/10209352 (Abstract)]


[[File:2010 VanNess Post exertional worsening of symptoms chart.png|right|frame|Post-exertional worsening of symptoms,<ref name="VanNess2010" />]]
[[File:2010 VanNess Post exertional worsening of symptoms chart.png|right|frame|Post-exertional worsening of symptoms,<ref name="VanNess2010" />]]

Revision as of 02:52, June 15, 2018

Post-exertional malaise (PEM) is a worsening of many ME/CFS symptoms as a result of physical or mental exertion. Patients, ME/CFS organizatons, clinicians and researchers that work in the ME/CFS field often referred to it as "the marker," i.e., the main symptom that differentiates ME and CFS from other fatiguing illnesses. PEM can last for days to weeks after the exertion.[1][2]

Worsening symptoms include chronic fatigue, flu-like symptoms, brain fog (cognitive dysfunction), unrefreshing sleep, chronic pain, orthostatic intolerance, neurally mediated hypotension, POTS and more. "As with the severity, the exertion needed to trigger PEM theories case-by-case. For some, it might kick in after a little bit of exercise on top of a day's regular activities. For others, is incredible as it may seem, it can just take a trip to the mailbox, a shower, or sitting upright for an hour." [3][4][5][6] Onset of PEM can be delayed 24-72 hours.[7]

A 2016 DePaul University study focused on deciphering if post-exertional malaise was a generalized, full-body fatigue and/or a muscle-specific fatigue. The results suggested that PEM is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.[8]

2015 Institute of Medicine report[edit | edit source]

PEM chart from the 2015 Institute of Medicine report

This landmark report published in 2015 by the United States Institute of Medicine report, which assessed all the evidence available, concluded:

"There is sufficient evidence that PEM is a primary feature that helps distinguish ME/CFS from other conditions"

Pages 84-86 of the report describe the evidence for post-exertional malaise in ME/CFS patients.[9]

Prevalence[edit | edit source]

Symptom recognition[edit | edit source]

Required[edit | edit source]

Optional[edit | edit source]

  • In the Fukuda criteria, the symptom of post-exertional malaise can be used to help form a diagnosis.[10] Unusually, it is not a required symptom for diagnosis.
  • In the Canadian Consensus Criteria PEM is an option with an and/or with fatigue although most researchers require PEM.
  • In the Holmes criteria, prolonged (24 hours or greater) generalized fatigue after levels of exercise that would have been easily tolerated in the patient's premorbid state is an optional criteria for diagnosis, under the section Minor Symptom Criteria.[11]

Notable studies[edit | edit source]

Post-exertional worsening of symptoms,[16]

Notable articles[edit | edit source]

Talks & interviews[edit | edit source]

Possible causes[edit | edit source]

Dysfunction of the ATP ADP cycle. Dr. Sarah Myhill has developed a test to assess ATP profiles. www.healthrising.org/forums/resources/hips-overview-of-dr-myhills-atp-work-in-chronic-fatigue-syndrome-me-cfs.390/

Potential treatments[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ Johnson, C, Health Rising: ME/CFS Symptoms, retrieved March 29, 2016
  2. ↑ Fighting Fatigue, Post-Exertional Malaise – A Hallmark Symptom of ME/CFS, retrieved March 29, 2016
  3. ↑ What Is Post-exertional Malaise - Very Well - Adrienne Dellwo
  4. ↑ Post Exertional Malaise - Very Well - Adrienne Dellwo
  5. ↑ Chronic Fatigue Syndrome - Web MD
  6. ↑ PEM Series - Solve ME/CFS - Jenny Spotila
  7. ↑ What Health - International CFS/ME Awareness Day 2017 - CFIDS Association of America
  8. ↑ 8.0 8.1 McManimen, SL; Sunnquist, ML; Jason, LA (2016), "Deconstructing post-exertional malaise: An exploratory factor analysis.", Journal of Health Psychology, doi:10.1177/1359105316664139, PMID 27557649
  9. ↑ Institute of Medicine report pages 84-86, search term exercise
  10. ↑ The CDC (Fukuda 1994) Definition for Chronic Fatigue Syndrome
  11. ↑ The 1988 Holmes Definition for CFS
  12. ↑ Lariel J. Mateo, University of the Pacific, Poster at 2018 Pacific Undergraduate Research and Creativity Conference (PURCC)
  13. ↑ Jason, LA; Zinn, ML; Zinn, MA (September 2015), "Myalgic Encephalomyelitis: Symptoms and Biomarkers", Current Neuropharmacology, 13(5): 701-734, doi:10.2174/1570159X13666150928105725
  14. ↑ Shukla, SK; Cook, D; Meyer, JD; et al. (December 18, 2015), "Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)", Plos One, 10(12), doi:10.1371/journal.pone.0145453
  15. ↑ Meyer, JD; Light, AR; Shukla, SK; Clevidence, D; Yale, S; Stegner, AJ; Cook, DB (October 2, 2013), "Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression", Fatigue: Biomedicine, Health & Behavior, 1 (4): 190-209, doi:10.1080/21641846.2013.838444
  16. ↑ VanNess, M; Stevens, S; Bateman, L; Stiles, TL; Snell, CR (February 2010), "Postexertional malaise in women with chronic fatigue syndrome", Journal of Women's Health, doi:10.1089/jwh.2009.1507, PMID 20095909
  17. ↑ ME Blogg (December 30, 2015), Suggestion to replace PEM by PAR
  18. ↑ Cook, DB (November 19, 2015), "Deciphering Post Exertion Malaise: The Intersection of Biology and Behavior", Solve ME/CFS (video)
  19. ↑ Spotila, JM (2010), "Post-Exertional Malaise in Chronic Fatigue Syndrome" (PDF), Solve ME/CFS
  20. ↑ Spotila, JM (May 23, 2012), "Post-Exertional Malaise: Cause and Effect", Solve ME/CFS
  21. ↑ About Health (October 8, 2015), Definition of Post-Exertional Malaise
  22. ↑ Post-Exertional Malaise - The ME/CFS Ghost

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

post-exertional neuroimmune exhaustion (PENE) - An alternative term for post-exertional malaise (PEM), used by people who find that the word 'malaise' fails to capture the serious nature of the condition. Used in the Institute of Medicine (IOM) report.

systemic exertion intolerance disease (SEID) - A term for ME/CFS that aims to avoid the stigma associated with the term "chronic fatigue syndrome", while emphasizing the defining characteristic of post-exertional malaise (PEM). SEID was defined as part of the diagnostic criteria put together by the Institute of Medicine (IOM) report of 10 February 2015.

plasma The liquid part of blood, lymph, or milk after removing any suspended material. Most of the time, "plasma" simply refers to blood, after all the blood cells have been removed. If you also remove the clotting factors, then the plasma is referred to as "serum".

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

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