Freeman, Roy · Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2002 · DOI
This review article examines whether ME/CFS might be caused by problems with the autonomic nervous system—the part of your body that controls automatic functions like heart rate and blood pressure. The author, Dr. Roy Freeman, discusses evidence suggesting that some ME/CFS patients do show signs of autonomic dysfunction, but emphasizes that this is not true for all patients with the condition.
Understanding whether autonomic dysfunction plays a role in ME/CFS could help explain symptoms like heart palpitations, dizziness upon standing, and exercise intolerance that many patients experience. This work encourages researchers to investigate autonomic testing as a potential diagnostic tool and therapeutic target for at least a subset of ME/CFS patients.
This review does not prove that autonomic dysfunction causes ME/CFS in all patients or that it is the primary mechanism of disease. The evidence presented suggests autonomic involvement in some cases, but the heterogeneous nature of ME/CFS means other biological pathways likely contribute to symptom development in different patient subgroups.
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
Freeman, Roy (2002). The chronic fatigue syndrome is a disease of the autonomic nervous system. Sometimes.. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. https://doi.org/10.1007/s10286-002-0058-2
BibTeX
@article{mecfsatlas-freeman-2002-chronic-fatigue,
author = {Freeman, Roy},
title = {The chronic fatigue syndrome is a disease of the autonomic nervous system. Sometimes.},
journal = {Clinical autonomic research : official journal of the Clinical Autonomic Research Society},
year = {2002},
doi = {10.1007/s10286-002-0058-2},
note = {PubMed: 12357274},
url = {https://www.mecfsatlas.com/evidence/freeman-2002-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/freeman-2002-chronic-fatigue
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