Bested, Alison C, Marshall, Lynn M · Reviews on environmental health · 2015 · DOI
This review helps doctors understand ME/CFS better by explaining what it is, how to diagnose it, and how to treat it. ME/CFS is a serious illness that causes extreme tiredness, brain fog, pain, and sleep problems that get worse after physical activity. The review emphasizes that pacing activities—carefully balancing rest with gentle exercise—is one of the most important strategies patients can use to manage their symptoms and avoid crashes.
This review is critical because most physicians lack training in ME/CFS diagnosis and management, leading to missed diagnoses and inappropriate care. By providing clinicians with practical diagnostic criteria and evidence-based management strategies, this work addresses a significant gap in medical education and can improve patient outcomes and reduce the substantial healthcare burden estimated at $17-24 billion annually in the US.
This review does not prove the underlying biological causes of ME/CFS, nor does it present new experimental evidence supporting specific treatment mechanisms. It also does not provide randomized controlled trial data comparing different management approaches—it represents expert consensus and synthesis rather than testing specific therapeutic hypotheses.
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
Bested, Alison C & Marshall, Lynn M (2015). Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians.. Reviews on environmental health. https://doi.org/10.1515/reveh-2015-0026
BibTeX
@article{mecfsatlas-bested-2015-review-myalgic,
author = {Bested, Alison C and Marshall, Lynn M},
title = {Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians.},
journal = {Reviews on environmental health},
year = {2015},
doi = {10.1515/reveh-2015-0026},
note = {PubMed: 26613325},
url = {https://www.mecfsatlas.com/evidence/bested-2015-review-myalgic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/bested-2015-review-myalgic
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