Silverman, Marni N, Heim, Christine M, Nater, Urs M et al. · PM & R : the journal of injury, function, and rehabilitation · 2010 · DOI
This review explores how three body systems—the stress response system, the nervous system, and the immune system—may work together to cause the overwhelming tiredness experienced in ME/CFS. The researchers found that people with chronic fatigue often have an underactive stress-response system, an overactive fight-or-flight response, and immune system imbalances. Understanding how these systems interact may help explain why rest alone doesn't always resolve the fatigue.
This work provides a unifying biological framework for understanding ME/CFS fatigue beyond psychological attribution, emphasizing measurable neuroendocrine and immune dysfunction. For patients, it validates that fatigue has identifiable physiological mechanisms; for researchers, it proposes specific testable hypotheses and noninvasive assessment methods for mechanistic studies.
This review does not prove causation—it describes associations between neuroendocrine dysfunction and fatigue. It does not establish which abnormalities are primary drivers versus secondary consequences of illness, nor does it demonstrate that correcting these imbalances will resolve fatigue in ME/CFS patients. The recommendations for noninvasive assessment methods are proposed but not empirically validated in this paper.
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
Silverman, Marni N, Heim, Christine M, Nater, Urs M, Marques, Andrea H, & Sternberg, Esther M (2010). Neuroendocrine and immune contributors to fatigue.. PM & R : the journal of injury, function, and rehabilitation. https://doi.org/10.1016/j.pmrj.2010.04.008
BibTeX
@article{mecfsatlas-silverman-2010-neuroendocrine-immune,
author = {Silverman, Marni N and Heim, Christine M and Nater, Urs M and Marques, Andrea H and Sternberg, Esther M},
title = {Neuroendocrine and immune contributors to fatigue.},
journal = {PM & R : the journal of injury, function, and rehabilitation},
year = {2010},
doi = {10.1016/j.pmrj.2010.04.008},
note = {PubMed: 20656615},
url = {https://www.mecfsatlas.com/evidence/silverman-2010-neuroendocrine-immune},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/silverman-2010-neuroendocrine-immune
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