Pall, M L, Satterlee, J D · Annals of the New York Academy of Sciences · 2001 · DOI
This theory paper proposes that ME/CFS, multiple chemical sensitivity (MCS), and post-traumatic stress disorder may share a common cause: abnormally high levels of nitric oxide and related harmful molecules in the body. The authors suggest that feedback loops—where one problem triggers another, which makes the first worse—could explain why these conditions become chronic and persist over time.
This study offers a potential unified biochemical mechanism that could explain why ME/CFS, chemical sensitivities, and trauma-related illness often co-occur or cluster in patients. If validated, such a common pathway could guide development of targeted treatments and help legitimize these conditions as biological diseases rather than psychosomatic disorders.
This is a theoretical framework, not an empirical study with patient data or experimental validation. It does not prove that nitric oxide/peroxynitrite elevation actually causes these conditions in humans, nor does it establish whether this mechanism is primary or secondary to other pathological processes. The hypothesis remains speculative until confirmed by direct biochemical measurement and intervention studies.
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 & Satterlee, J D (2001). Elevated nitric oxide/peroxynitrite mechanism for the common etiology of multiple chemical sensitivity, chronic fatigue syndrome, and posttraumatic stress disorder.. Annals of the New York Academy of Sciences. https://doi.org/10.1111/j.1749-6632.2001.tb05836.x
BibTeX
@article{mecfsatlas-pall-2001-elevated-nitric,
author = {Pall, M L and Satterlee, J D},
title = {Elevated nitric oxide/peroxynitrite mechanism for the common etiology of multiple chemical sensitivity, chronic fatigue syndrome, and posttraumatic stress disorder.},
journal = {Annals of the New York Academy of Sciences},
year = {2001},
doi = {10.1111/j.1749-6632.2001.tb05836.x},
note = {PubMed: 12000033},
url = {https://www.mecfsatlas.com/evidence/pall-2001-elevated-nitric},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/pall-2001-elevated-nitric
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