Pall, M L · Medical hypotheses · 2001 · DOI
This study proposes that ME/CFS, fibromyalgia, multiple chemical sensitivity, and PTSD may all share the same root cause: a buildup of harmful molecules called nitric oxide and peroxynitrite in the body. These molecules can create a self-perpetuating cycle that keeps the illness going once it starts, often triggered by a period of stress. The same biochemical problem appearing in different tissues might explain why these conditions overlap and share similar symptoms.
If validated, this unified mechanistic framework could explain why ME/CFS patients often meet criteria for multiple overlapping conditions and why stress frequently precedes disease onset. Such a mechanism would also suggest specific biochemical targets for therapeutic intervention and could guide future research toward testable predictions about biomarkers and treatment strategies.
This is a theoretical framework, not experimental evidence. It does not prove that elevated nitric oxide/peroxynitrite is the actual cause of these conditions, only that the hypothesis is biochemically plausible and consistent with existing literature. The study does not provide original patient data, biomarker measurements, or controlled trials, so it cannot establish causation or quantify the role of this mechanism relative to other potential contributors.
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
Pall, M L (2001). Common etiology of posttraumatic stress disorder, fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivity via elevated nitric oxide/peroxynitrite.. Medical hypotheses. https://doi.org/10.1054/mehy.2001.1325
BibTeX
@article{mecfsatlas-pall-2001-common-etiology,
author = {Pall, M L},
title = {Common etiology of posttraumatic stress disorder, fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivity via elevated nitric oxide/peroxynitrite.},
journal = {Medical hypotheses},
year = {2001},
doi = {10.1054/mehy.2001.1325},
note = {PubMed: 11461161},
url = {https://www.mecfsatlas.com/evidence/pall-2001-common-etiology},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/pall-2001-common-etiology
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