Abrahamsen, Cathrine, Beadsworth, Mike, Bostock, Will et al. · Scandinavian journal of primary health care · 2026 · DOI
This guideline helps doctors understand why some patients have lasting physical symptoms like fatigue, pain, and brain fog that don't show up on tests or scans. The authors explain that these symptoms often arise from how the brain responds to perceived threats, influenced by what people expect and have learned from past experiences. They recommend that doctors validate patients' symptoms, explain why they persist, and work with patients to create personalized treatment plans that address physical, psychological, and social factors together.
ME/CFS patients often face dismissal or inadequate care when symptoms lack clear biomedical explanations. This guideline legitimizes the patient experience while offering clinicians a coherent framework—grounded in neuroscience—for understanding symptom persistence and implementing compassionate, evidence-based care that may improve outcomes and reduce the frustration of repeated investigations and unhelpful consultations.
This guideline does not prove that biopsychosocial interventions will work for all ME/CFS patients, nor does it establish causation in any individual case. It is a narrative review and consensus statement, not a randomized controlled trial, so it cannot quantify treatment efficacy or identify which specific interventions are most effective. The framework proposed may not fully capture the pathophysiology of ME/CFS, which involves documented immune and metabolic abnormalities.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Abrahamsen, Cathrine, Beadsworth, Mike, Bostock, Will, Chalder, Trudie, Flottorp, Signe, Fors, Egil A, et al. (2026). Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach to promote recovery.. Scandinavian journal of primary health care. https://doi.org/10.1080/02813432.2026.2633765
BibTeX
@article{mecfsatlas-abrahamsen-2026-persistent-physical,
author = {Abrahamsen, Cathrine and Beadsworth, Mike and Bostock, Will and Chalder, Trudie and Flottorp, Signe and Fors, Egil A and Garner, Paul and Hadfield, Sarah and Kennedy, Becca and Kuehn, Rebecca and Landmark, Live and Launes, Gunvor and Liira, Helena and Linnestad, Lina and Rotkirch Virrantaus, Hélène and Vangelova-Korpinen, Velina},
title = {Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach to promote recovery.},
journal = {Scandinavian journal of primary health care},
year = {2026},
doi = {10.1080/02813432.2026.2633765},
note = {PubMed: 41823400},
url = {https://www.mecfsatlas.com/evidence/abrahamsen-2026-persistent-physical},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/abrahamsen-2026-persistent-physical
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