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A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 77 damage, and much more have been found to be possible contributors. But the consistent overlap of several key signs and symptoms has led researchers to propose there may be a common pathophysiology that links these problems. CORE PAIS SYMPTOMS Every person who has a persistent postinfection issue is likely to have a unique experience, but observers have collected a group of signs and symptoms that appear consistently in many versions of this situation. These include exertion intolerance, disproportionate fatigue, neurocognitive disruption ("brain fog"), dysautonomia, sensory impairment, flu-like symptoms (fever, malaise, nausea, sweating), cough, shortness of breath, weakness, unrefreshing sleep, and muscle and joint pain. You may recognize that this list can describe many situations, including fibromyalgia, hypothyroidism, and incompletely treated diabetes, but those conditions are not (yet) associated with a pre-occurring infection. EXAMPLES OF PAIS Both CFS and long COVID—the most widely acknowledged forms of PAIS—are recognized by their symptomatic profile rather than by a specific pathophysiology. This points out how subjective the identification of these problems can be, and how difficult it is to create a consistent and accurate set of diagnostic criteria. Following are a few examples of PAIS. I've chosen most of these because massage therapists are likely to have clients who live with these conditions. KEY POINT • Postacute infection syndrome has been poorly understood, but it is being studied. Clients with these problems may seek out massage therapy because the conventional medical community has little to offer them. Long COVID Also called postacute sequelae of COVID (PASC), long COVID is a driver for much of the current research into PAIS. The specific definition of long COVID is still under debate, with the World Health Organization, the Centers for Disease Control and Prevention, and others having their own ideas about severity, duration of symptoms, and possible contributing factors. While many people with long COVID have the core signs and symptoms of all PAIS conditions, the persistent loss of the senses of smell and taste (anosmia and ageusia) that many patients experience is unique to this condition. ME/CFS This condition, called CFS in the US and Canada, and myalgic encephalomyelitis (ME) in many other places, is now often referred to as ME/CFS. Historically, this collection of signs and symptoms has been associated with a prolonged recovery from infection with Epstein- Barr virus (EBV ), the causative agent of mononucleosis. That is an oversimplification, and many people who meet the diagnostic criteria for ME/CFS have no signs of EBV infection. Furthermore, it has been shown that exposure to several other pathogens can result in diagnostically identical signs and symptoms. ME/ CFS is recognized as the cornerstone of PAIS, and some experts now consider that what begins as long COVID may eventually evolve into ME/CFS. Chronic Lyme, Posttreatment Lyme Disease Syndrome Some people who contract the bacterial infection called Lyme disease develop long-term symptoms that range from being mildly discomforting to being completely debilitating. These include the core PAIS symptoms, but people with chronic Lyme may also report alarming experiences with peripheral neuropathy, arrhythmia, and more. This topic is explored in the July/August