03/05/2026
Are you struggling with PEM?
Post-exertional malaise, or PEM, is not just feeling extra tired. It is a dramatic worsening of multiple symptoms (often called a “crash”) that can be triggered by going beyond your body’s energy threshold via physical, mental, and/or emotional exertion. Even sensory overload (like too much light or sound exposure) can trigger PEM in some cases. Even fun activities like hanging out with friends or cheering for your favorite sports team can trigger PEM. A PEM crash can leave someone bedbound or functioning at a significantly lower baseline for days, weeks, or even months or more. Having PEM makes it difficult to plan activities, work, go to school, engage in social activities, or manage everyday tasks.
PEM is a hallmark symptom of ME/CFS, and occurs in many people with Long COVID as well. For people who experience PEM, it is often the symptom that most severely limits daily life and independence.
Research-supported treatments exist that may help reduce the frequency and/or severity of PEM crashes and raise one’s energy threshold before PEM is triggered. We know it can take some time to find a treatment that works, and we’ve seen many patients positively respond, sometimes drastically, to these medications.
Have any of these treatments made a difference for your PEM symptoms? Share in the comments, please.
For treatment suggestions personalized to your health history, try RTHM’s HIPAA-compliant intelligence platform.
www.rthm.com