Post-exertional malaise

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Revision as of 16:09, November 7, 2016 by Samsara (talk | contribs) (fixed references)

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]

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]

  • 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 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, 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]

  1. Johnson, C, Health Rising: ME/CFS Symptoms, retrieved March 2016 Check date values in: |access-date= (help)
  2. Fighting Fatigue, Post-Exertional Malaise – A Hallmark Symptom of ME/CFS, retrieved March 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. 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. 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
  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. Cook, DB (November 19, 2015), "Deciphering Post Exertion Malaise: The Intersection of Biology and Behavior", Solve ME/CFS (video)
  16. Spotila, JM (2010), "Post-Exertional Malaise in Chronic Fatigue Syndrome" (PDF), Solve ME/CFS
  17. Spotila, JM (May 23, 2012), "Post-Exertional Malaise: Cause and Effect", Solve ME/CFS
  18. About Health (October 8, 2015), Definition of Post-Exertional Malaise
  19. Post-Exertional Malaise - The ME/CFS Ghost

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