Living with Chronic Pain

7 Tips for Dealing With Post-Exertional Malaise


Post-exertional malaise (PEM) occurs when symptoms such as fatigue, brain fog, headaches, and muscle aches worsen 12 to 48 hours after physical or mental exertion. It is a common occurrence for individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

PEM can be severe and interfere with daily activities. However, incorporating the following seven tips may help manage, limit, or prevent PEM flare-ups:

  1. Keep track of symptoms. Keeping a diary of activities and symptoms, including symptom intensity and duration, can help determine PEM triggers. Changes can then be made to reduce or avoid PEM as much as possible.
  2. Practice activity management or pacing. Using an activity/symptom diary can help determine limits for mental and physical activity. Activities and periods of rest can then be planned accordingly. Some medical professionals refer to this as staying within the “energy envelope.”
  3. Avoid the activity/crash cycle. It may be tempting to engage in too much activity on a good day; unfortunately, this can lead to a PEM flare-up or crash. After recovering from the crash, the cycle can start again. Activity and rest should be balanced, even on good days, to help avoid this vicious cycle.
  4. Find ways to make tasks easier. Try breaking large tasks into smaller steps, allowing for rest between each step. Make accommodations such as placing a chair in front of the kitchen sink or stove to sit on while washing dishes or cooking.
  5. Consider wearing a heart rate monitor. It may be helpful to wear a heart rate monitor to keep track of how hard the body is working. A prolonged increased heart rate may indicate that rest is needed to avoid PEM. Working with a medical professional to identify target heart rates is beneficial.
  6. Be patient. Finding the right balance between activity and rest takes time. It requires some trial and error. PEM can also occur unexpectedly. For these reasons, try to avoid feeling guilty when a flare-up or crash occurs.
  7. Rest in a quiet, dark room. When PEM does occur, it is often helpful to rest in a dark, quiet room. During rest, avoid screens and other forms of stimulation.

These tips can help individuals avoid PEM as much as possible and cope with it when it does occur.

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