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Post-exertional malaise
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===Psychological paradigm === ====Dismissed as disturbed effort perceptions or kinesiophobia ==== [[File:Brian vastag.png|thumb|right|[[Brian Vastag]] is an American and award-winning journalist and an ME/CFS patient that won a disability case against Prudential, proving that PEM is a severe symptom that keeps him from gainful employment]] The existence of PEM as a distinctive and complex symptom of ME/CFS has been dismissed in early research into the disease. Some interpreted it as just fatigue after exercise<ref name="CDC-questionnaire">{{Cite web|url = https://www.cdc.gov/me-cfs/pdfs/symptom-inventory-questionnaire-508.pdf | title = Symptoms Inventory Questionnaire {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2018-05-18 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2018-11-21}}</ref>, while others saw it as an artifact of disturbed effort perceptions<ref name="Laurie1997">{{Cite journal | last = Lawrie | first = S. M. | last2 = Machale | first2 = S.M. | last3 = Power | first3 = M.J. | last4 = Goodwin | first4 = G.M. | date=Sep 1997 | title = Is the chronic fatigue syndrome best understood as a primary disturbance of the sense of effort?|url=https://www.cambridge.org/core/journals/psychological-medicine/article/editorial-is-the-chronic-fatigue-syndrome-best-understood-as-a-primary-disturbance-of-the-sense-of-effort/434A5EB2C5B4F971A4A36C1DC3400A7E|journal=Psychological Medicine|language=en|volume=27|issue=5 | pages = 995β999|issn=1469-8978}}</ref><ref>{{Cite journal | last = Rosen | first = S D | last2 = King | first2 = J C | last3 = Wilkinson | first3 = J B | last4 = Nixon | first4 = P G | date = Dec 1990 | title = Is chronic fatigue syndrome synonymous with effort syndrome?|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292947/|journal=Journal of the Royal Society of Medicine|volume=83|issue=12 | pages = 761β764|issn=0141-0768|pmc=1292947|pmid=2125315}}</ref><ref>{{Cite journal | last = Wallman | first = Karen E. | last2 = Sacco | first2 = Paul | date = Jan 2007 | title = Sense of effort during a fatiguing exercise protocol in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/17365951|journal=Research in Sports Medicine|volume=15|issue=1 | pages = 47β59|doi=10.1080/15438620601184331|issn=1543-8627|pmid=17365951}}</ref> or an [[Illness beliefs|irrational fear of movement]]<ref>{{Cite journal | last = Silver | first=A. | last2 = Haeney | first2 = M. | last3 = Vijayadurai | first3 = P. | last4 = Wilks | first4 = D. | last5 = Pattrick | first5 = M. | last6 = Main | first6 = C.J. | date = Jun 2002 | title = The role of fear of physical movement and activity in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12069873|journal=Journal of Psychosomatic Research|volume=52|issue=6 | pages = 485β493|issn=0022-3999|pmid=12069873}}</ref><ref name="Fischler1997">{{Cite journal | last = Fischler | first=B. | last2 = Dendale | first2 = P. | last3 = Michiels | first3 = V. | last4 = Cluydts | first4 = R. | last5 = Kaufman | first5 = L. | last6 = De Meirleir | first6 = K. | authorlink6 = Kenny De Meirleir | date = Apr 1997 | title = Physical fatigability and exercise capacity in chronic fatigue syndrome: association with disability, somatization and psychopathology|url=https://www.ncbi.nlm.nih.gov/pubmed/9160276|journal=Journal of Psychosomatic Research|volume=42|issue=4|pages=369β378|issn=0022-3999|pmid=9160276}}</ref>. One example of this is the [[Tampa scale for kinesiophobia]], adapted for [[chronic fatigue syndrome]]. Some of the questions in this scale ask about the experience of PEM such as: "If I were to try to overcome it, my symptoms would increase" or "my symptoms let me know when to stop exercising so that I do not harm myself". Yet these symptoms are classified as an indicator of [[illness beliefs|irrational fear of movement and exercise]], instead of PEM.<ref>{{Cite web|url=http://www.paininmotion.be/EN/sem-TSK-CFSEnglish.pdf | title = Tampa Scale Kinesiophobia - Version Chronic Fatigue Syndrome | last = Nijs | first = J | last2 = De Meirleir | first2 = K | date = 2004 | website = painmotion.be|publisher=Archives of Physical Medicine and Rehabilitation|archive-url=|archive-date=|url-status=|access-date= | last3 = Duquet | first3 = W}}</ref>
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