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

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
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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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)

Pacing to Boost Energy and Avoid Crashes

Dr. Alison Bested explains what pacing is, why pacing is important to prevent worsening of illness, and tried and tested pacing strategies to stop crashing and gain energy.

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The Power of Neuroplasticity

Dr. Howard Schubiner, an internist and clinical professor at MSU, shares evidence-based steps to unlearn chronic pain, depression, anxiety and fatigue, and helps you determine if your condition may respond to Pain Reprocessing Therapy.

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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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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, Second Edition
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 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.

The second edition has updated disease definitions, research updates, online resources, peer-reviewed references, and a bonus chapter, New and Future Directions, with new strategies to leverage the body's innate ability to heal.

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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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The Dr. Eleanor Stein Podcast

Episode 24 - Why Does Medicine Ignore the Sodium-Potassium Pump in Post-Exertional Malaise? with guest Dr. Klaus Wirth

Episode 12: Movement as Medicine: Rebuilding Strength Without Crashing with guest Caroline Jordan

Episode 3: The 5 Types of Fatigue and How to Treat Them with guest Dr. Jenny Tufenkian

These are the most current Podcasts on the topic of fatigue and PEM.
For all Podcasts, click here.

Using Wearable Trackers to Pace Better and Decrease PEM

Did you know that the data you get from your wearable tracker can help you improve your pacing and energy levels?

In this presentation to ME International on May 10, 2024, Dr. Stein explains

the contributors to and symptoms of post-exertional malaise (PEM)
basic pacing strategies to keep your energy stable and minimize crashes
how to use heart rate and heart rate variability data from your wearable tracker to improve pacing
lots of Q&A

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.