Post-exertional malaise

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Post-exertional malaise (PEM) is a worsening of many ME/CFS symptoms as a result of physical or mental exertion. It is often referred to as "the marker" by patients, ME/CFS organizatons, clinicians and researchers that work in the ME/CFS field. 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]

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.[8]

Prevalence[edit | edit source]

Symptom recognition[edit | edit source]

Notable studies[edit | edit source]

Post-exertional worsening of symptoms, VanNess et al 2010.png

Notable articles[edit | edit source]

Talks & interviews[edit | edit source]

Possible causes[edit | edit source]

Potential treatments[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

<references>

[16]

[13]

[2]

[10]

[1]

[12]

[9]

[11]

[14]

[15]

[18]

[19]

[20]

  1. ↑ 1.0 1.1 Johnson, C, Health Rising: ME/CFS Symptoms, retrieved Mar 2016 Check date values in: |access-date= (help)
  2. ↑ 2.0 2.1 Fighting Fatigue, Post-Exertional Malaise – A Hallmark Symptom of ME/CFS, retrieved Mar 2016 Check date values in: |access-date= (help)
  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. ↑ Institute of Medicine report pages 84-86, search term exercise
  9. ↑ 9.0 9.1 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
  10. ↑ 10.0 10.1 Jason, LA; Zinn, ML; Zinn, MA (September 2015), "Myalgic Encephalomyelitis: Symptoms and Biomarkers", Current Neuropharmacology, 13(5): 701-734, doi:10.2174/1570159X13666150928105725
  11. ↑ 11.0 11.1 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
  12. ↑ 12.0 12.1 ME Blogg (December 30, 2015), Suggestion to replace PEM by PAR
  13. ↑ 13.0 13.1 Cook, DB (November 19, 2015), "Deciphering Post Exertion Malaise: The Intersection of Biology and Behavior", Solve ME/CFS (video)
  14. ↑ 14.0 14.1 Spotila, JM (2010), "Post-Exertional Malaise in Chronic Fatigue Syndrome" (PDF), Solve ME/CFS
  15. ↑ 15.0 15.1 Spotila, JM (May 23, 2012), "Post-Exertional Malaise: Cause and Effect", Solve ME/CFS
  16. ↑ 16.0 16.1 About Health (October 8, 2015), Definition of Post-Exertional Malaise
  17. ↑ Post-Exertional Malaise - The ME/CFS Ghost
  18. ↑ Nijs, J; Van Oosterwijck, J; Meeus, M; Lambrecht, L; Metzger, K; Frémont, K; Paul, L (April 2010), "Unravelling the nature of postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: the role of elastase, complement C4a and interleukin-1beta", Journal of Internal Medicine, doi:10.1111/j.1365-2796.2009.02178.x, PMID 20433584 Invalid |display-authors=7 (help)
  19. ↑ Van Oosterwijck, J; Nijs, J; Meeus, M; Lefever, I; Huybrechts, L; Lambrecht, L; Paul, L (September 2010), "Pain inhibition and postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an experimental study", Journal of Internal Medicine, doi:10.1111/j.1365-2796.2010.02228.x, PMID 20412374 Invalid |display-authors=7 (help)
  20. ↑ 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 Invalid |display-authors=5 (help)

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 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.

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