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][2] PEM can be described as "a delayed and significant exacerbation of ME/CFS symptoms that always follows physical activity and often follows cognitive activity".[3] PEM is considered a cardinal symptom by a number of the different diagnostic criteria for ME/CFS, including the International Consensus Criteria.[4][5][6]


  1. ^ "Unravelling the nature of post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: The role of elastase, complement C4a and interleukin-1β". ME Research UK. Retrieved 23 September 2017.
  2. ^ Jason, Leonard A.; Evans, Meredyth; So, Suzanna; Scott, Jilian; Brown, Abigail (13 January 2015). "Problems in Defining Post-Exertional Malaise". Journal of Prevention & Intervention in the Community. 43 (1): 20–31. doi:10.1080/10852352.2014.973239. PMC 4295644.
  3. ^ "Comments Post-exertional malaise in ME/CFS: Medical Research Council announces new neuroimaging research". ME Association. 16 October 2015. Retrieved 23 September 2017.
  4. ^ "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.
  5. ^ 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.
  6. ^ 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.