Post-Exertional Malaise in long COVID compared to ME/CFS
Researchers at the Bateman Horne clinic in Utah, USA asked long COVID and ME/CFS patients about PEM which they described as:
“an unusual worsening of symptoms after minimal physical or mental exertion, which can occur or persist 24 hours or more after the exertion”
The majority in both groups indicated PEM occurred within hours of exertion and lasted for several days. Fatigue, muscle and joint pain, infection and immune reaction, neurologic and gastrointestinal symptoms, and orthostatic intolerance all worsened.
Long COVID respondents reported significantly more sleepiness, respiratory issues, depression and anxiety, irregular body temperature and excessive thirst than ME/CFS patients. Difference could be due to the nature of the COVID virus or because ME/CFS patients had been sick longer and had learned to manage some symptoms better.
The majority of both groups rested to recover from PEM, plus a variety of things to recover including sleep, hydration, and diet. Most ME/CFS patients used physical awareness to prevent PEM whereas Long COVID respondents prevented PEM by avoiding triggers.
The researchers believe “Asking about PEM in people that have lingering symptoms following COVID-19 is essential to mitigate progression and possible development of ME/CFS.”
Post-exertional malaise among people with long COVID compared to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), by Suzanne D Vernon, Megan Hartle, Karena Sullivan, Jennifer Bell, Saeed Abbaszadeh, Derya Unutmaz, Lucinda Bateman in Work, pp. 1-8, 2023 Mar 2023 [doi: 10.3233/WOR-220581]
Research abstract:
Background:
Long COVID describes a condition with symptoms that linger for months to years following acute COVID-19. Many of these Long COVID symptoms are like those experienced by patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Objective:
We wanted to determine if people with Long COVID experienced post-exertional malaise (PEM), the hallmark symptom of ME/CFS, and if so, how it compared to PEM experienced by patients with ME/CFS.
Methods:
A questionnaire that asked about the domains of PEM including triggers, experience, recovery, and prevention was administered to 80 people seeking care for Long COVID at Bateman Horne Center. Their responses were compared to responses about PEM given by 151 patients with ME/CFS using chi-square tests of independence.
Results:
All but one Long COVID respondent reported having PEM. There were many significant differences in the types of PEM triggers, symptoms experienced during PEM, and ways to recover and prevent PEM between Long COVID and ME/CFS. Similarities between Long COVID and ME/CFS included low and medium physical and cognitive exertion to trigger PEM, symptoms of fatigue, pain, immune reaction, neurologic, orthostatic intolerance, and gastrointestinal symptoms during PEM, rest to recover from PEM, and pacing to prevent PEM.
Conclusion:
People with Long COVID experience PEM. There were significant differences in PEM experienced by people with Long COVID compared to patients with ME/CFS. This may be due to the newness of Long COVID, not knowing what exertional intolerance is or how to manage it.
