Resources for Fatigue & PEM

Bounce Back from Fatigue and
Post Exertional Malaise.

Add more useful hours to your day with
Dr. Stein’s courses, mentorship, and materials.

Let’s do this.

Bounce Back from Fatigue and Post Exertional Malaise.

Add more useful hours to your day with
Dr. Stein’s courses, mentorship, and materials.

Let’s do this.

What is Fatigue and Post-Exertional Malaise?

Fatigue is one of the most common reasons for seeking medical care. It’s a general term that refers to having insufficient energy to carry out desired tasks.

Cognitive and body fatigue occurs with many conditions, including myalgic encephalomyelitis (ME), chronic fatigue syndrome (CFS), fibromyalgia (FM), environmental sensitivities (ES), long COVID and chronic pain.
It’s an internal experience that’s hard to measure.
For this reason, medical professionals often dismiss complaints of fatigue or, if taken seriously, do not fully investigate them.
Post-exertional malaise (PEM) refers to a prolonged worsening of symptoms after minimal physical, emotional or mental exertion.
It’s the hallmark symptom of ME and CFS and is common in long COVID and fibromyalgia.
PEM is triggered by ordinary activities that healthy people tolerate.
Typically, PEM begins 12 to 48 hours after the activity that triggers it and, by definition, lasts more than 24 hours.
It’s highly variable and may persist much longer.
PEM is especially disabling because increasing activity increases PEM, which can last for days to weeks or, for the severely ill, even forever. This stops people in their tracks.

Pacing is the most effective management strategy for people with fatigue and PEM.

Pacing is accommodating your activities to your energy level, not the other way around.
Core pacing skills—such as breaking activities into small chunks, setting a timer to avoid overdoing it, and resting before and after tiring activities—can help people build sustainable, predictable energy and have a better quality of life.

Online Courses

Self-Study Course
Pathways to Improvement

Learn to take charge of your health to help you feel and live better. Pacing and working within your energy envelope can make a big difference. Self-management works!

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Live Online Mentorship
Pathways In Action

Learn to individualize and optimize your self-management with the support of a mentor and group. Ask your questions in the live sessions about how to decrease fatigue and avoid PEM.

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Membership to Live Sessions
Live! with Dr. Stein

Evidence-based presentations and Q&A with Dr. Stein. Credible, science-based, and cutting edge information about how to live longer and healthier.

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Self-Study Course
Pathway 3: Sleep

Better sleep means less pain and more comfort. Wake more refreshed and have more energy to enjoy life by learning proven self-management strategies for more effective sleep.

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Webinars (recordings)

Deep Pacing

Dr. Stein explains DEEP pacing—providing strategies for attending holistically to the mind and body, to stabilize your energy, make your life and health more predictable, and give you more control.

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Vagus Nerve

Dr. Navaz Habib explains how the vagus nerve controls essential body functions like breathing and inflammation. He shares simple exercises to activate the vagus nerve and improve your health.

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Causes & Treatment

Dr. Neil Nathan explains how to solve underlying causes of ME, CFS, FM and ES. Learn strategies to recover from mold and infections that make people sensitive and reactive.

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Books

Let Your Light Shine Through
In this manual, Dr. Stein shares the strategies she has found to be the most successful for patients in her 35-year medical practice working with ME, CFS, FM, ES, chronic pain, and more recently, long Covid. Readers are guided through a 286-page, 4-month program specific to these conditions. Let Your Light Shine Through is filled with practical, no-to-low-cost management suggestions, tools and resources. Formats available: hardcopy coil-bound and digital download.

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More Light

Building upon Let Your Let Shine Through, More Light contains up-to-date, science-based information, clinical approaches, and affordable interventions you can do on your own. Currently, only individual chapters are available at affordable prices. Choose the subjects tailored specifically to your health needs. Current topics are Self-management, Diagnosis, Biology of Change, Sleep, and Energy and Activity.

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Recommended Free Videos

Part 1: What is ME/CFS?

In this video, Dr. Stein describes ME/CFS. It includes a 5-minute video of the same name from the Bateman Horne Centre (used with permission). Each of the criteria suggested in the 2015 IOM/NAM report is explained. The Bateman Horne video is a cartoon and easily accessible to all viewers.

Part 2: Diagnosis

In this recording, Dr. Stein describes the questions a healthcare practitioner could ask a patient to confirm whether they meet the criteria for ME/CFS. She also describes some of the conditions that frequently accompany ME. If you are a patient, consider what your answers are to these questions. Dr. Stein has included audio clips from real patients answering these questions to give a feel of the lived experience of ME/CFS.

Part 3: Management

In this recording, Dr. Stein introduces the most helpful management strategies for each of the common symptoms of ME/CFS, those included in the SEID criteria, the Canadian Consensus Criteria, and the conditions that often accompany ME. She includes audio clips from real patients to help give you an idea of what these symptoms are like and how people have improved over time. There is hope.

What Can Help Heal Your Pain?
An interview with Simon Pimenta

Simon lives in the UK and had ME/CFS and fibromyalgia for 8 years. In this video, Simon talks to Dr. Stein on the topic of healing pain using neuroplasticity and other approaches.

Podcast with Dr. Courtney Craig

In this episode, Dr. Courtney Craig and I discuss our shared experience of how a diagnosis of ME/CFS led us, professionally, to help others manage the condition. I describe how self-management strategies can impact biology and therefore improve patients' lives.

Spoonie Radio is a Chronic Fatigue Syndrome & Fibromyalgia Podcast highlighting effective treatment strategies as well as insight from clinicians, researchers, and advocates. This show is brought to you by Dr. Courtney Craig, recovered CFS patient and clinician. Click on the link below to listen to the podcast www.drcourtneycraig.com.