Evidence Atlas

Underuse of Pharmacologic Therapies for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Before Specialist Evaluation. — ME/CFS Atlas

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E2 ModerateCohortPEM unclearCross-SectionalPeer-reviewed

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Underuse of Pharmacologic Therapies for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Before Specialist Evaluation.

Grach, Stephanie L, Seltzer, Jaime, Mueller, Michael R et al. · Annals of family medicine · 2026 · DOI

Quick Summary

A study of 571 ME/CFS patients in Minnesota found that about two-thirds had tried at least one medication before seeing a specialist, and over 70% had used dietary supplements. The researchers observed that medications commonly recommended by ME/CFS specialists—such as certain antidepressants and gabapentin—appear to be prescribed less often by general doctors compared to pain and anxiety medications. It remains unclear whether this pattern reflects clinical caution, lack of awareness, or other factors in primary care practice.

Why It Matters

This study documents a potential gap between medications used by ME/CFS specialists and those prescribed in general medical practice, offering preliminary evidence that ME/CFS patients may receive inconsistent pharmacologic management before specialist referral. Understanding prescribing patterns is relevant for identifying barriers to evidence-informed symptom management in primary care and for informing clinician education initiatives.

Observed Findings

In this referral cohort, 68.3% of patients had been prescribed at least one medication potentially used for ME/CFS symptom management before specialist evaluation.
The most commonly prescribed medications associated with this pattern were serotonin-norepinephrine reuptake inhibitors, gabapentin, and tricyclic antidepressants.
In the same cohort, 72.2% of patients reported use of at least one dietary supplement, most commonly vitamin D, B-complex vitamins, and fish oil.
Use of pharmacotherapy for ME/CFS-specific symptoms (outside pain and anxiety management) was observed to be limited relative to supplements and pain/anxiety medications.
The pattern was observed at the point of specialist consultation, indicating medication use had occurred in primary care or other non-specialist settings.

Inferred Conclusions

The authors suggest that potentially helpful pharmacologic therapies for ME/CFS may be underprescribed in general medical practice compared to specialist recommendations.
They infer that patients may turn to dietary supplements as an alternative when pharmacologic options are not offered or discussed.
The authors interpret these findings as indicating a practice gap and propose that improved clinician education about available treatment options could enhance symptom management.
They frame this gap as a potential contributor to the burden of this 'debilitating disease' and suggest a need for better dissemination of treatment guidance to non-specialists.

What This Study Does Not Prove

This study does not establish whether underuse of pharmacotherapy is harmful, beneficial, or neutral for patients. It does not demonstrate efficacy of any medication for ME/CFS, nor does it prove that specialist-recommended medications are more effective than alternatives or standard care. It does not generalise beyond a single regional referral centre and cannot account for reasons why general practitioners may prescribe or withhold particular drugs.

Topics

Interventions

Metadata

DOI: 10.1370/afm.250266
PMID: 42055743
Evidence level: Single-study or moderate support from human research
Last updated: 30 April 2026

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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 →

Cite this study

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

Grach, Stephanie L, Seltzer, Jaime, Mueller, Michael R, Aakre, Chris A, Natividad, Lasonya T, Lawson, Donna K, et al. (2026). Underuse of Pharmacologic Therapies for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Before Specialist Evaluation.. Annals of family medicine. https://doi.org/10.1370/afm.250266

BibTeX

@article{mecfsatlas-grach-2026-underuse-pharmacologic,
  author  = {Grach, Stephanie L and Seltzer, Jaime and Mueller, Michael R and Aakre, Chris A and Natividad, Lasonya T and Lawson, Donna K and Ganesh, Ravindra and Hurt, Ryan T},
  title   = {Underuse of Pharmacologic Therapies for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Before Specialist Evaluation.},
  journal = {Annals of family medicine},
  year    = {2026},
  doi     = {10.1370/afm.250266},
  note    = {PubMed: 42055743},
  url     = {https://www.mecfsatlas.com/evidence/grach-2026-underuse-pharmacologic},
}

Atlas snapshot reference

ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-05. https://www.mecfsatlas.com/evidence/grach-2026-underuse-pharmacologic

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