E0 ConsensusHigher confidencePEM unclearReview-NarrativePeer-reviewedReviewed
Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
Grach, Stephanie L, Seltzer, Jaime, Chon, Tony Y et al. · Mayo Clinic proceedings · 2023 · DOI
Quick Summary
This review explains how doctors can diagnose and manage ME/CFS, a serious illness that causes extreme tiredness and other symptoms, often starting after an infection. The authors note that ME/CFS shares many similarities with long COVID, the condition some people experience after having COVID-19. They provide practical guidance to help healthcare providers recognize and treat this condition.
Why It Matters
This guideline is important because it addresses a critical gap in clinical practice by providing generalists with clear diagnostic and management strategies for ME/CFS, a disease often underrecognized or misdiagnosed. Given the substantial overlap with post-COVID syndrome affecting millions of patients, this guidance has broad relevance for improving patient care and reducing diagnostic delays.
Observed Findings
- Approximately half of patients with post-COVID syndrome meet diagnostic criteria for ME/CFS
- ME/CFS is frequently preceded by infection
- ME/CFS is classified as a chronic neurologic disease
- Significant clinical overlap exists between ME/CFS and post-COVID syndrome
Inferred Conclusions
- Generalist practitioners need practical frameworks for recognizing and managing ME/CFS
- Post-COVID syndrome should prompt consideration of ME/CFS diagnostic criteria
- The overlap between ME/CFS and post-COVID syndrome suggests shared pathophysiologic mechanisms or disease features
- Improved diagnostic and management strategies are needed for this underrecognized chronic condition
Remaining Questions
- What are the specific underlying biological mechanisms causing ME/CFS and post-COVID syndrome?
- Do ME/CFS and post-COVID syndrome represent identical conditions or distinct entities with overlapping features?
- Which management strategies are most effective for ME/CFS, and what evidence supports current clinical recommendations?
What This Study Does Not Prove
This review does not establish new causal mechanisms of ME/CFS or prove the effectiveness of specific treatments through clinical trial data. It does not demonstrate differences between ME/CFS and post-COVID syndrome, only their overlap, and cannot determine whether they represent the same underlying condition.
Tags
Method Flag:PEM_UNCLEARExploratory OnlyPEM Not Defined
Symptom:Post-Exertional MalaiseCognitive DysfunctionUnrefreshing SleepPainFatigue
Phenotype:Infection-TriggeredLong COVID Overlap
Metadata
- DOI
- 10.1016/j.mayocp.2023.07.032
- PMID
- 37793728
- Review status
- Editor reviewed
- Evidence level
- Higher-level evidence type — systematic reviews, meta-analyses, guidelines, or major syntheses (study type, not a quality guarantee)
- Last updated
- 7 April 2026
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 →
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