Post-exertional malaise

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Post-exertional malaise (PEM) is one of the main symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).[1] PEM is "a delayed and significant exacerbation of ME/CFS symptoms that always follows physical activity and often follows cognitive activity".[2][unreliable medical source?]

PEM is considered a cardinal symptom by a number of the different diagnostic criteria for ME/CFS, including the International Consensus Criteria (ICC).[3][4][5][unreliable medical source?] The Canadian Consensus Criteria (CCC) does not consider PEM compulsory, rather it requires "post exertional malaise and/or [post exertional] fatigue".[6][7] The National Academy of Medicine's (NAM) Systemic Exertion Intolerance Disease (SEID) criteria (also called IOM 2015 Diagnostic Criteria) requires PEM.[8][9][10] The Centers for Disease Control and Prevention (CDC) use the SEID/IOM 2015 Diagnostic Criteria on its website's ME/CFS page and list PEM as a primary symptom.[9][11]


  1. ^ Brown, Abigail; Jason, Leonard A (2020). "Meta-analysis investigating post-exertional malaise between patients and controls". Journal of Health Psychology. 25 (13–14): 2053–2071. doi:10.1177/1359105318784161. PMC 7440642. PMID 29974812.CS1 maint: PMC embargo expired (link)
  2. ^ "Comments Post-exertional malaise in ME/CFS: Medical Research Council announces new neuroimaging research". ME Association. 16 October 2015. Retrieved 23 September 2017.
  3. ^ "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Symptoms". Centers for Disease Control and Prevention. U.S. Department of Health & Human Services. 14 July 2017. Retrieved 23 September 2017.
  4. ^ Carruthers, B. M.; van de Sande, M. I.; De Meirleir, K. L.; Klimas, N. G.; Broderick, G.; Mitchell, T.; Staines, D.; Powles, A. C. P.; Speight, N.; Vallings, R.; Bateman, L.; Baumgarten-Austrheim, B.; Bell, D. S.; Carlo-Stella, N.; Chia, J.; Darragh, A.; Jo, D.; Lewis, D.; Light, A. R.; Marshall-Gradisbik, S.; Mena, I.; Mikovits, J. A.; Miwa, K.; Murovska, M.; Pall, M. L.; Stevens, S. (October 2011). "Myalgic encephalomyelitis: International Consensus Criteria". Journal of Internal Medicine. 270 (4): 327–338. doi:10.1111/j.1365-2796.2011.02428.x. PMC 3427890. PMID 21777306.
  5. ^ Maes, Michael; Anderson, George; Morris, Gerwyn; Berk, Michael (27 February 2013). "Diagnosis of myalgic encephalomyelitis: where are we now?". Expert Opinion on Medical Diagnostics. 7 (3): 221–225. doi:10.1517/17530059.2013.776039. PMID 23480562.
  6. ^ Myhill S, Booth NE, McLaren-Howard J; Booth; McLaren-Howard (2009). "Chronic fatigue syndrome and mitochondrial dysfunction" (PDF). Int J Clin Exp Med. 2 (1): 1–16. PMC 2680051. PMID 19436827.CS1 maint: multiple names: authors list (link)
  7. ^ Carruthers, Bruce M; van de Sande, Marjorie I. "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners" (PDF). p. 8. There is an inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigability, post exertional malaise and/or fatigue and/or pain and a tendency for other associated symptoms within the patient's cluster of symptoms to worsen.
  8. ^ "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Key Facts" (PDF). 2015. p. 2.
  9. ^ a b "IOM 2015 Diagnostic Criteria | Diagnosis | Healthcare Providers | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC". 2018-11-08. Retrieved 2019-03-08.
  10. ^ Wright Clayton, Ellen; Alegria, Margarita; Bateman, Lucinda; Chu, Lily; Cleeland, Charles; Davis, Ronald; Diamond, Betty; Ganlats, Theodore; Keller, Betsy (2015). "Beyond Myalgic Encephalomyelits/Chronic Fatigue Syndrome: Redefining an Illness (Report Guide for Clinicians)" (PDF). Nancy Klimas, A. Martin Lerner, Cynthia Mulrow, Benjamin Natelson, Peter Rowe, Michael Shelanski. National Academy of Medicine (Institutes of Medicine). p. 7.
  11. ^ "Symptoms of ME/CFS | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC". 2019-01-18. Retrieved 2019-03-08.