Oral, A, Ilieva, E M, Küçükdeveci, A A et al. · European journal of physical and rehabilitation medicine · 2013
This paper describes how rehabilitation doctors in Europe can help patients with widespread and localized soft tissue pain conditions, including ME/CFS. The authors review the best available evidence for treatments like exercise, cognitive behavioral therapy, physical therapies, and newer techniques like brain stimulation to reduce pain and improve quality of life.
This guideline is important for ME/CFS patients because it provides a systematic, evidence-based framework for how rehabilitation specialists should assess and manage ME/CFS and related soft tissue pain conditions using a holistic, functioning-focused approach. It specifically endorses graded exercise therapy and cognitive behavioral therapy for CFS, though the strength and applicability of these recommendations continue to be debated in the ME/CFS community.
This guideline does not prove that any single intervention will work for all ME/CFS patients, nor does it establish the optimal intensity, duration, or personalization of these treatments. It does not address potential harms from exercise in ME/CFS, particularly post-exertional malaise (PEM), nor does it provide evidence that recommendations developed for fibromyalgia necessarily apply equally to ME/CFS. The guideline reflects 2013 evidence and may not capture more recent findings about ME/CFS pathophysiology.
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
Oral, A, Ilieva, E M, Küçükdeveci, A A, Varela, E, Valero, R, Berteanu, M, et al. (2013). Generalised and regional soft tissue pain syndromes. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee.. European journal of physical and rehabilitation medicine. https://pubmed.ncbi.nlm.nih.gov/24084413/
BibTeX
@article{mecfsatlas-oral-2013-generalised-regional,
author = {Oral, A and Ilieva, E M and Küçükdeveci, A A and Varela, E and Valero, R and Berteanu, M and Christodoulou, N},
title = {Generalised and regional soft tissue pain syndromes. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee.},
journal = {European journal of physical and rehabilitation medicine},
year = {2013},
note = {PubMed: 24084413},
url = {https://www.mecfsatlas.com/evidence/oral-2013-generalised-regional},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/oral-2013-generalised-regional
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