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A structured evidence atlas for ME/CFS research.

6,145 studies on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), classified by diagnostic criteria, evidence level, and post-exertional malaise status. Research domains include immune-system findings, neuroinflammation, autonomic nervous system, energy metabolism, Long COVID overlap, and more.

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How to read this atlas

What every page on this site is, and what it is not.

What this atlas is

  • A structured index of ME/CFS research.
  • Summaries are drafted by a program from each paper’s title and abstract.
  • Classifications — evidence level, research approach, and paradigm — are produced by the same automated pipeline, not by an editor.

What this atlas is not

  • Not reviewed by a clinician or peer reviewer.
  • Not a medical resource, and not medical advice.
  • Not a systematic review or clinical guideline.
Editorial policy →How a study gets on this atlas →

Evidence mix

How the 6,145 public studies in this atlas split by evidence level. Evidence level reflects study type, not methodological quality — a weak review still sits at E0.

E0 Consensus637 · 10%
E1 Replicated320 · 5%
E2 Moderate2,768 · 45%
E3 Preliminary2,420 · 40%

Landmark Research

Foundational studies that shaped the understanding of ME/CFS.

All studies →
E1 ReplicatedCohortPEM requiredObservational

Metabolic features of chronic fatigue syndrome

Robert K. Naviaux, Jane C. Naviaux, Kefeng Li et al.·Proceedings of the National Academy of Sciences (PNAS)·2016·n=84

This study analyzed blood metabolites from 84 ME/CFS patients and 45 healthy controls using untargeted metabolomics. Researchers found 80% of the abnormal metabolites were decreased in ME/CFS patients, suggesting a hypometabolic state — the body running in energy conservation mode. The pattern resembled a 'dauer-like' state seen in organisms under stress.

BiomarkersEnergy Metabolism
E1 ReplicatedCohortPEM requiredObservational

Cardiopulmonary exercise testing and post-exertional malaise in ME/CFS: A retrospective analysis

Staci R. Stevens, Christopher R. Snell, Jared N. Stevens et al.·Journal of Translational Medicine·2018·n=51

ME/CFS patients underwent two consecutive days of cardiopulmonary exercise testing (CPET). On the second day, patients showed significantly reduced VO2 max and anaerobic threshold compared to the first day — and compared to healthy and disease controls who recovered normally. This objective impairment matches the subjective PEM experience.

DiagnosticsPost-Exertional Malaise
E0 ConsensusGuidelinePEM requiredGuideline

Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness

Institute of Medicine Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome·National Academies Press·2015

The US Institute of Medicine reviewed over 9,000 scientific articles to establish new diagnostic criteria for ME/CFS. The report introduced SEID (Systemic Exertion Intolerance Disease) as a proposed name and established that ME/CFS is a serious, chronic, complex systemic disease. New criteria require PEM, unrefreshing sleep, plus cognitive impairment or orthostatic intolerance.

DiagnosticsPost-Exertional Malaise
E2 ModerateReviewPEM unclearReview-Narrative

The neuroinflammatory hypothesis of chronic fatigue syndrome/myalgic encephalomyelitis: an update

Jarred W. Younger, Linda Yan, Sean Mackey·Journal of Neuroinflammation·2014·n=18

Using thermography and brain temperature imaging at Stanford, this study found evidence consistent with neuroinflammation — specifically elevated brain temperature — in ME/CFS patients compared to healthy controls. Brain regions associated with pain and fatigue showed the strongest signal.

Neuroinflammation

Research Domains

Structured synthesis of what is known, uncertain, and emerging across ME/CFS research.

All domains →

Recently Added

All studies →
E0 ConsensusDiagnosticPEM requiredMethods-Paper

Recommended long COVID outcome measures and their implications for clinical trial design, with a focus on post-exertional malaise.

Soares, Letícia, Davis, Hannah, Spier, Ezra et al.·EBioMedicine·2026

This paper provides guidance for researchers designing clinical trials to test treatments for long COVID, with special attention to post-exertional malaise (PEM)—a key symptom where people feel much worse after physical or mental activity. The authors recommend that trials should carefully measure patients at the start, track them over time, include a placebo group for comparison, and make sure patients in different treatment groups have similar severity of illness. The paper highlights that the field urgently needs funding to develop better ways to measure these outcomes before large-scale treatment trials can succeed.

Post-Exertional Malaise
E0 ConsensusReviewPEM unclearSystematic-Review

Evaluating working memory functioning in individuals with myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review and meta-analysis.

Penson, Maddison, Kelly, Kate·Psychology, health & medicine·2026

This study reviewed 34 research papers to understand how ME/CFS affects working memory—the ability to hold and use information in your mind briefly. The researchers found that people with ME/CFS have significant difficulties with verbal working memory (remembering words and language), but their ability to remember visual information (like images or patterns) appeared similar to people without ME/CFS. This suggests that cognitive problems in ME/CFS may affect certain types of thinking more than others.

Cognitive Impairment
E2 ModerateCohortPEM unclearCross-Sectional

Understanding concussion in myalgic encephalomyelitis/chronic fatigue syndrome: Findings from the 2023 National Health Interview study.

Sirotiak, Zoe, Adamowicz, Jenna L, Thomas, Emily B K·Brain injury·2026

This study found that people with ME/CFS are nearly 5 times more likely to have had a concussion in the past year compared to people without ME/CFS. People with ME/CFS also experienced more falls and dizziness or balance problems. The researchers suggest that doctors should screen patients with ME/CFS more carefully for concussions and take steps to reduce their concussion risk.

Autonomic Nervous System

Research paradigm over time

How the share of biomedical vs. psychosomatic vs. neutral research has changed year by year within the 6,145 public studies in this atlas. Values are a 3-year rolling average of the paradigm mix by publication year, not raw counts.

This describes the atlas’s corpus composition over time, not the overall ME/CFS research field. The “biomedical” bucket is a classifier-assigned label for studies with explicitly biomedical framing; many biologically relevant observational and review studies sit in “neutral” instead. Studies without a publication year in 1990–2026 are not plotted. How we classify paradigms →

Biomedical 71%Psychosomatic 11%Neutral 18%

Research paradigm in this atlas

How the 6,145 public studies in this atlas split between biomedical, neutral, and psychosomatic research paradigms, by decade. These percentages describe the atlas’s corpus composition, not the overall ME/CFS research field. Inclusion depends on the PubMed query and the classifier’s paradigm tagging; a field-level claim requires different methods.

The “biomedical”bucket here labels studies whose stance the classifier read as explicitly biomedical — mechanistic, physiological, or biological framing. Many biologically relevant observational cohorts, reviews, and diagnostic studies land in the “neutral”bucket instead, because the paper itself takes no explicit paradigm stance. “Biomedical” here is narrower than “all biologically relevant ME/CFS research”. How we classify paradigms →

Each value is the share of studies published in that period that carry a given paradigm label. Raw totals per decade, not a rolling average.

All 6,145 studies in atlas61% biomedical
Biomedical 61%Neutral 21%Psychosomatic 18%

Decade by decade

1990sn=900
58% biomedical22% neutral20% psychosomatic
2000sn=1,345
55% biomedical21% neutral24% psychosomatic
2010sn=1,926
61% biomedical20% neutral19% psychosomatic
2020sn=1,894
69% biomedical20% neutral11% psychosomatic

Trust principles

Six principles that guide every entry.

Machine-drafted, evidence-first

Every summary is drafted by a program from the paper's abstract and anchored to the cited study. We show the evidence level so you can judge for yourself.

PEM-centered

Post-exertional malaise is the defining feature of ME/CFS. We flag whether each study accounts for it.

Uncertainty visible

We show what we don't know alongside what we do. Every entry carries an evidence level and explicit limitations.

Sources cited

Every study links to the original paper — DOI, PubMed, or journal — so you can verify everything.

Low-energy design

Quiet mode, readable summaries, and energy-rated entries so you can access the atlas at any capacity level.

Open knowledge

All atlas content is freely accessible. No paywalls, no registration, no dark patterns.

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