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. 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.

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 29 March 2016 
  2. Fighting Fatigue, Post-Exertional Malaise – A Hallmark Symptom of ME/CFS, retrieved 29 March 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. (18 December 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 (2 Oct 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 (30 Dec 2015), Suggestion to replace PEM by PAR 
  18. Cook, DB (19 Nov 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 (23 May 2012), "Post-Exertional Malaise: Cause and Effect", Solve ME/CFS 
  21. About Health (8 Oct 2015), Definition of Post-Exertional Malaise 
  22. Post-Exertional Malaise - The ME/CFS Ghost

The information provided at this site is not intended to diagnose or treat any illness.

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history