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1) The research team of Leonard Jason has published the DSQ-PEM-2, a new short questionnaire to assess post-exertional malaise (PEM). It includes extra questions about multiple PEM triggers, delayed onset, and prolonged recovery. But there are also some issues...

2) The most popular PEM questionnaire in use is the DSQ-PEM, which was also designed by the Jason team. However, it does not assess important PEM domains, such as triggers or delayed onset. There's also a more extensive questionnaire, the DPEMQ, but it's long and impractical.

3) This new questionnaire is meant to replace the DSQ-PEM. It's a short 10-item tool to quickly assess PEM and see if people meet ME/CFS case definitions. You can check out the questionnaire here: www.explorationpub.c...

4) The researchers tested this questionnaire in ca. 1500 ME/CFS patients and found that the typical duration of PEM was from 24 hours to 1 week, with a delay in symptoms from 24 to 48 hours. 12% said that PEM lasted > 2 years, indicating PEM also includes long-term worsening.

5) The table below shows triggers included in the questionnaire and how common these are. It's notable how many are not directly related to exertion, such as cold, positional change, noise, foods, chemicals, etc. (Not sure if it's an improvement to include all of these).

7) The DSQ-PEM-2 also asks about the symptoms patients had due to PEM in the past 6 months. For each one must give a score from 0 to 4 for both frequency and severity. A problem, however, is that some questions still seem to refer to fatigue after exertion, not PEM.

8 ) Examples are: 'Dead, heavy feeling after starting to exercise’, ‘Next day soreness or fatigue after non-strenuous, everyday activities’ ‘Mentally tired after the slightest effort’ ‘Minimum exercise makes you physically tired’ 'Physically drained or sick after mild activity'

9) As someone noted, this is "almost a perfect list of things I want people to understand are not PEM." There are also issues with the scoring algorithm, as it gives a higher score to more triggers, longer PEM duration, and less effectiveness of pacing.