Romano, Graziella F, Tomassi, Simona, Russell, Alice et al. · Advances in psychosomatic medicine · 2015 · DOI
This review examines what scientists have learned about the biological causes of ME/CFS and fibromyalgia. Researchers have found that three main systems in the body appear to go wrong: inflammation (the body's immune response), oxidative stress (cellular damage from harmful molecules), and problems with hormones that control stress responses. These abnormalities may explain why patients experience fatigue, pain, memory problems, and mood changes.
This review consolidates evidence for specific biological mechanisms in ME/CFS, moving beyond purely psychosomatic explanations and establishing that measurable, objective physiological abnormalities characterize these conditions. Identifying consistent biological pathways (inflammation, oxidative stress, HPA dysfunction) is essential for developing targeted treatments and validating ME/CFS as a biomedically-grounded disease.
This review does not establish causality—it documents associations between biological abnormalities and symptoms without proving which factors initiate disease. It also does not clarify whether these abnormalities are primary drivers of ME/CFS/FM or secondary consequences of prolonged illness, nor does it provide sufficient data to determine which patients show which abnormalities. As a narrative review rather than original research, it reflects the mixed and sometimes conflicting findings in the literature.
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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Primary citation
Romano, Graziella F, Tomassi, Simona, Russell, Alice, Mondelli, Valeria, & Pariante, Carmine M (2015). Fibromyalgia and chronic fatigue: the underlying biology and related theoretical issues.. Advances in psychosomatic medicine. https://doi.org/10.1159/000369085
BibTeX
@article{mecfsatlas-romano-2015-fibromyalgia-chronic,
author = {Romano, Graziella F and Tomassi, Simona and Russell, Alice and Mondelli, Valeria and Pariante, Carmine M},
title = {Fibromyalgia and chronic fatigue: the underlying biology and related theoretical issues.},
journal = {Advances in psychosomatic medicine},
year = {2015},
doi = {10.1159/000369085},
note = {PubMed: 25832514},
url = {https://www.mecfsatlas.com/evidence/romano-2015-fibromyalgia-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/romano-2015-fibromyalgia-chronic
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