Clauw, D J, Chrousos, G P · Neuroimmunomodulation · 1997 · DOI
This review examines fibromyalgia and chronic fatigue syndrome, two conditions with overlapping symptoms of pain and exhaustion that have been described throughout medical history under different names. The authors propose that both conditions stem from problems in the central nervous system—the brain and spinal cord—particularly in areas that control hormone levels, pain sensing, and automatic body functions. They suggest that immune system changes seen in these conditions are side effects rather than root causes.
This early framework hypothesizing CNS dysfunction as central to ME/CFS pathogenesis has influenced subsequent research directions and helped legitimize these conditions as neurobiological disorders rather than purely psychiatric. For patients, this work validates that their symptoms reflect measurable physiological problems in the nervous system, not imagination or psychological disturbance.
This review does not prove that CNS dysfunction causes ME/CFS or fibromyalgia—it presents a hypothesis for future testing. The proposal that immune changes are epiphenomenal rather than causal is an inference, not an established fact. The review does not demonstrate which specific CNS components are primarily dysfunctional or establish the relative contributions of genetic versus environmental factors.
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
Clauw, D J & Chrousos, G P (1997). Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms.. Neuroimmunomodulation. https://doi.org/10.1159/000097332
BibTeX
@article{mecfsatlas-clauw-1997-chronic-pain,
author = {Clauw, D J and Chrousos, G P},
title = {Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms.},
journal = {Neuroimmunomodulation},
year = {1997},
doi = {10.1159/000097332},
note = {PubMed: 9500148},
url = {https://www.mecfsatlas.com/evidence/clauw-1997-chronic-pain},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/clauw-1997-chronic-pain
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