Post-Exertional Malaise

These few paragraphs describe what my daily life is like.  Not me individually, of course, but the average ME/CFS patient.  I like the way pacing is described, also, how resting up ahead of time can be beneficial, and how pushing through something can cause a crash and more severe symptoms.  This is how making myself get up and see 3 clients (even though I need the income) when I'm feeling quite poor can cost me a whole day of activities..just so I can make $60.  bleh.  Okay, here ya go...

Pacing, according to Dr. Campbell, is a multi-layered process of adaptation. People can gain control by finding and staying within limits in four areas: physical activity, mental activity, social activity and physical sensitivities. Instead of one energy envelope, Campbell says that every type of activity (such as standing, talking, driving, or using a computer) has its own envelope or limit. “Chronic illness has different rules than acute illness,” Campbell says. CFS cannot be pushed through or overcome because “the body will always win, and exact a punitive price for small mistakes.” Just as overdrawing a checking account by $2 can result in disproportionate bank fees, Campbell notes that exceeding one’s energy limits by one hour could lead to a week or more of suffering and PEM.



Pacing offers a wide variety of practices and behaviors that can help patients learn to better manage their limitations and avoid that suffering. Pacing strategies include reducing activity level, taking daily planned rests, setting activity limits, switching among tasks, and keeping detailed records. Campbell points out that, “Pacing also includes making mental adjustments based on acceptance that life has changed. Acceptance is not resignation, but rather an acknowledgment of the need to live a different kind of life. Pacing is not a single action or strategy, but rather a way of living with CFS.”


The first and most important strategy recommended by Dr. Campbell is pre-emptive rest according to a planned schedule rather than in reaction to symptoms.10 Rest breaks are integrated into a person’s daily routine, regardless of how the patient is feeling. By taking scheduled rest, lying down with eyes closed, patients have found that they can avoid PEM while still accomplishing the same tasks. The length and timing of rest breaks will vary from person to person, although severely ill patients may need many brief rests throughout the day (e.g., 15 minutes of rest every hour or two).

Excerpted from:
http://www.cfids.org/cfidslink/2010/090103.asp