{"id":7736,"date":"2016-03-22T10:04:22","date_gmt":"2016-03-22T10:04:22","guid":{"rendered":"http:\/\/wames.org.uk\/cms-english\/?p=7736"},"modified":"2016-03-22T10:04:22","modified_gmt":"2016-03-22T10:04:22","slug":"post-activity-relapse-par-or-pem","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/post-activity-relapse-par-or-pem\/","title":{"rendered":"Post Activity Relapse (PAR) or PEM?"},"content":{"rendered":"<p>Another contribution to the discussion of the key characteristic of ME, Post Exertional Malaise (PEM), comes from\u00a0Kasper Ezelius of the Sweish patient group ME-f\u00f6reningen: <a href=\"http:\/\/me-cfs.se\/blogg\/suggestion-to-replace-pem-by-par\/\" target=\"_blank\">Suggestion to replace PEM by PAR<\/a><\/p>\n<p>Deterioration after mental or physical exertion is often referred as \u201cpost exertional malaise\u201d (PEM). But the word malaise, is very far from what it is. In the Swedish medical dictionary malaise is defined as a vague diffuse sense of discomfort and tiredness. But the patients rather experience a crash with an increase of most of the symptoms.<\/p>\n<p>To be clear that the entire symptom complex deteriorates, it would be better to replace the word \u201cmalaise\u201d with \u201crelapse\u201d. Relapse also better describes that it takes some days to recover. Post exertional malaise could be interpreted like a few minutes of feeling slightly unwell after running.<\/p>\n<p>The exertion does not need to feel like an exertion at the time the patient is doing it, and it would be better to replace the word \u201cexertion\u201d with \u201cactivity\u201d. So an improved term of \u201cpost exertional malaise\u201d (PEM) would be \u201cpost activity relapse\u201d (PAR). I think post activity relapse is a far better description, and I hope future disease descriptions, clinical guides and research articles use this terminology. I think post activity relapse is short enough in order to use it several times in a text, without being felt as too burdensome, but I think it is important to clarify somewhere in the text that the activity can be both of mental and physical kind.<\/p>\n<p>The term \u201crelapse after mental or physical activity\u201d has the advantage of being clear that:<\/p>\n<ul>\n<li>both physical and mental activity create worsening<\/li>\n<li>it must not be an exertion in the classical sense, but rather an activity<\/li>\n<li>the worsening does not only create malaise, but a whole range of the ME symptoms are worsened (hyperacusis, orthostatic intolerance, need to rest, cognitive difficulties, pain, etc).<\/li>\n<li>it takes days to recover<\/li>\n<\/ul>\n<p>The relapse does not need to occur directly after the exertion, but it may take a few days (1-3 days, sometimes more) before the deterioration starts. This has been described by Dr John L Whiting from Australia in the message list Co-Cure the 9th of December 2015. For the case there is a delay in the relapse, I suggest that the term \u201cdelayed post activity relapse\u201d (DPAR) is used, but that it is also clarified that the activity can be both mental and physical.<\/p>\n<p>Example of use:<br \/>\nA patient with ME must have post activity relapse (PAR), which is a relapse after mental or physical activity. A patient may at occations experience a delayed onset of the PAR, and this is called delayed post activity relapse (DPAR).<\/p>\n<p>Summary<br \/>\nPost exertional malaise is proposed to be replaced by \u201crelapse after mental or physical activity\u201d, but for repeated use a shorter form can be used: \u201cpost activity relapse\u201d which can be abbreviated \u201cPAR\u201d.<\/p>\n<p>At the occations the onset is delayed the term \u201crelapse with delayed onset after mental or physical activity\u201d is used, but for repeated use a shorter term can be used: \u201cdelayed post activity relapse\u201d which can be abbreviated \u201cDPAR\u201d.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Another contribution to the discussion of the key characteristic of ME, Post Exertional Malaise (PEM), comes from\u00a0Kasper Ezelius of the Sweish patient group ME-f\u00f6reningen: Suggestion to replace PEM by PAR Deterioration after mental or physical exertion is often referred as &hellip; <a href=\"https:\/\/wames.org.uk\/cms-english\/post-activity-relapse-par-or-pem\/\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[2552,2553,2551,584,2550,585,2195],"class_list":["post-7736","post","type-post","status-publish","format-standard","hentry","category-news","tag-dpar","tag-kasper-ezelius","tag-par","tag-pem","tag-post-activity-relapse","tag-post-exertional-malaise","tag-sweden"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-20M","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/7736","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=7736"}],"version-history":[{"count":2,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/7736\/revisions"}],"predecessor-version":[{"id":7740,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/7736\/revisions\/7740"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=7736"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=7736"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=7736"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}