yogabook / pathology / PEM post-exertional malaise
Definition of
Post-exertional malaise is the term used to describe a delayed deterioration of the patient’s condition in the context of various disorders of CFS or post-viral syndrome. PEM is one of the cardinal symptoms of ME/CFS that goes beyond the usual post-viral syndrome. One of the criteria for CFS is that the PEM persists at least the day after the trigger. The worsening of the condition occurs after inadequate exertion that any healthy person would tolerate without problems, sometimes even simple activities such as showering or visiting a shop to buy groceries. The time delay until onset is usually 12 – 48 hours. It is not possible to predict how long the PEM will then last,
In some cases, the deterioration can be irreversible or last for many months. The triggering stresses can be of a different nature, they do not have to be purely physical activities, cognitive demands can trigger PEM just as much as emotional ones, such as joy or emotional stress. Even if the symptoms of worsening of the condition due to excessive demands during a relapse of IBD are similar, even simple blood parameters are likely to signify a classic deepening of the relapse symptoms, so that there is no PEM in the strict sense.
According to one study, the average recovery time after a 2-day cardiopulmonological exercise test is two weeks.
Cause
- Exertion beyond a currently tolerable level in the presence of a health disorder (see below)
Predisposing
– Health factors / illnesses
Diagnosis
- Clinical
Symptoms
- Myalgia
- Cephalgia
- Arhtralgia
- Flu-like symptoms: feeling ill, weakness, fatigue, swelling of the lymph nodes
- Brain fog, concentration disorders, word-finding disorders, memory disorders
- Sensitivity to light and noise
- Sleep disorders, inadequate recovery after a good night’s sleep
Complications
- Each occurrence of a PEM harbours the risk of chronification at the level suffered.
Therapy
- the 3P rule is obligatory (pacing, planning, prioritising)