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Post-exertional malaise
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====Currently used as the hallmark symptom defining ME/CFS==== Post-exertional malaise was recognized as a symptom of [[chronic fatigue syndrome]] in the 1994 [[Fukuda criteria]], but did not fully describe it, and only identified it as an optional symptom.<ref name="fukuda1994">{{Cite journal | last = Fukuda | first = K. | author-link = Keiji Fukuda | last2 = Straus | first2 = S.E. | authorlink2 = Stephen Straus | last3 = Hickie | first3 = I. | authorlink3 = Ian Hickie | last4 = Sharpe | first4 = M.C. | authorlink4 = Michael Sharpe | last5 = Dobbins | first5 = J.G. | authorlink5 = James Dobbins | last6 = Komaroff | first6 = A. | authorlink6 = Anthony Komaroff | date = 1994-12-15 | title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url = https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953β959|issn=0003-4819|pmid=7978722|via=|publisher=American College of Physicians}}</ref> The 2003 [[Canadian Consensus Criteria]] (CCC) for ME/CFS used PEM as the key compulsory symptom for diagnosis. The CCC's were the first criteria to stress that the onset of PEM could be delayed and to describe its debility as a [[flu-like symptoms|flu-like distress]].<ref name="CCC">{{Cite journal | last = Carruthers | first = Bruce M. | last2 = Jain | first2 = Anil Kumar | last3 = De Meirleir | first3 = Kenny L. | last4 = Peterson | first4 = Daniel L. | last5 = Klimas | first5 = Nancy G. | last6 = Lerner | first6 = A. Martin | last7 = Bested | first7 = Alison C. | last8 = Flor-Henry | first8 = Pierre | last9 = Joshi | first9 = Pradip | date = Jan 2003 | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v11n01_02|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=11|issue=1 | pages = 7β115|doi=10.1300/j092v11n01_02|issn=1057-3321}}</ref> [[Canadian Consensus Criteria#Definition|PEM and/or post-exertional fatigue]] is a mandatory symptom under the CCC criterion.<ref name="CCC-overview">{{Cite web|url=http://www.investinme.org/Documents/PDFdocuments/Canadian_ME_Overview_A4.pdf | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners - An Overview fo the Canadian Consensus Document | last = Carruthers | first = Bruce | authorlink=Bruce Carruthers | last2 = van de Sande | first2 = Marjorie | authorlink2 = Marjorie van de Sande | date = |website=Invest in ME Research | pages = 4|type=|archive-url=|archive-date=|url-status=|access-date=|quote=Physical or mental exertion often causes debilitating malaise and/or fatigue, generalized pain, deterioration of cognitive functions, and worsening of other symptoms that may occur immediately after activity or be delayed. Patients experience rapid muscle fatigue and lack endurance.}}</ref> The [[International Consensus Criteria]] for [[myalgic encephalomyelitis |ME]] replaced post-exertional malaise with a similar symptom of [[post-exertional neuroimmune exhaustion]], though this criteria is rarely used in clinical practice.<ref name="ICC" /> The [[National Academy of Medicine]] 2015 report describes PEM more generally as "an exacerbation of some or all of an individual's ME/CFS symptoms that occurs after physical or cognitive exertion and leads to a reduction in functional ability." The report confirmed PEM as the hallmark symptom of ME/CFS and advised to rename the disease accordingly to [[Systemic Exertion Intolerance Disease]] (SEID).<ref name="IOM2015" /> PEM is a mandatory symptom under the SEID criterion, which was adopted by the [[Centers for Disease Control|CDC]] and is used as the current ME/CFS criteria.<ref name="CDC-symptoms" /> The UK uses the [[NICE ME/CFS diagnostic criteria 2021|NHS diagnostic criteria]], which were changed in 2021 to use post-exertional malaise as the hallmark symptom a required (compulsory) symptom that is needed for ME/CFS to be diagnosed.<ref name="CDC-symptoms" /><ref name="GuidelinesChange2021" />
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