Evidence browser

Chronic fatigue syndrome in the emergency department.

Timbol, Christian R, Baraniuk, James N·Open access emergency medicine : OAEM·2019

This study surveyed 282 people with ME/CFS to understand their experiences in emergency departments (EDs). About 59% had visited an ED, often due to symptoms like dizziness or severe fatigue. Many patients reported that ED staff didn't understand their illness and sometimes dismissed their symptoms as psychological rather than physical, leading to poor experiences and feelings that they weren't taken seriously.

E2 ModerateBehavioralPEM not requiredObservational

Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study.

Nacul, Luis, de Barros, Barbara, Kingdon, Caroline C et al.·Diagnostics (Basel, Switzerland)·2019

Researchers tested blood samples from 272 people with ME/CFS and 136 healthy people to look for measurable differences that might help diagnose the condition. They found that people with severe ME/CFS had notably lower levels of an enzyme called creatine kinase (CK) in their blood compared to healthy people and those with milder ME/CFS. This is the first study to report this pattern, suggesting that CK levels might be useful for identifying who has the most severe form of the disease.

Biomarkers

Sleep education in primary school prevents future school refusal behavior.

Maeda, Tsutomu, Oniki, Kentaro, Miike, Teruhisa·Pediatrics international : official journal of the Japan Pediatric Society·2019

This study tested whether teaching primary school children about healthy sleep habits could prevent school refusal (persistent avoidance of attending school) later on. Researchers in Japan had students track their sleep for 2 weeks, gave them feedback, and taught them and their parents about the importance of regular sleep schedules. After the program started, school refusal rates dropped dramatically—from 10% of graduates in 2007 to 0% by 2012.

Sleep

Changes in the transcriptome of circulating immune cells of a New Zealand cohort with myalgic encephalomyelitis/chronic fatigue syndrome.

Sweetman, Eiren, Ryan, Margaret, Edgar, Christina et al.·International journal of immunopathology and pharmacology·2019

Researchers studied blood immune cells from 10 ME/CFS patients and 10 healthy people to understand what's different at the genetic level. They found that several genes related to inflammation were more active in ME/CFS patients, and genes related to energy production and circadian rhythms (your body's internal clock) showed abnormal patterns. These findings suggest ME/CFS involves multiple biological systems working incorrectly at the same time.

E2 ModerateCohortPEM unclearCase-Control

Patients with Fibromyalgia and Chronic Fatigue Syndrome show increased hsCRP compared to healthy controls.

Groven, Nina, Fors, Egil A, Reitan, Solveig Klæbo·Brain, behavior, and immunity·2019

This study measured inflammation markers in the blood of people with ME/CFS and fibromyalgia, compared to healthy people. Both patient groups had higher levels of a marker called hsCRP (a sign of inflammation) than healthy controls. The two conditions showed similar inflammation levels, suggesting they may share some biological similarities.

BiomarkersImmune System

Immunosignature Analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

Günther, Oliver P, Gardy, Jennifer L, Stafford, Phillip et al.·Molecular neurobiology·2019

Researchers used a specialized test to examine antibodies (immune proteins) in the blood of people with ME/CFS and healthy controls. They found a pattern of 256 specific protein signatures in ME/CFS patients' blood that was different from healthy people. This suggests the immune system may be reacting to past infections in a way that could help doctors diagnose ME/CFS in the future.

Differentiating Post-Polio Syndrome from Myalgic Encephalomyelitis and Chronic Fatigue Syndrome.

Klebek, Lauren, Sunnquist, Madison, Jason, Leonard A·Fatigue : biomedicine, health & behavior·2019

This study compared three similar long-term illnesses that cause fatigue and muscle problems: Post-polio syndrome (PPS), ME, and CFS. Researchers used questionnaires and computer analysis to identify which symptoms best distinguish these conditions from each other. They found that people with ME/CFS tend to have more severe overall functional impairment than those with PPS, and that three specific areas—brain fog, post-exertional malaise (getting worse after activity), and hormone-related symptoms—are most helpful in telling these illnesses apart.

E2 ModerateCohortPEM not requiredCross-Sectional

Evidence for similarity in symptoms and mechanism: The extra-pulmonary symptoms of severe asthma and the polysymptomatic presentation of fibromyalgia.

Hyland, Michael E, Lanario, Joseph W, Wei, Yinghui et al.·Immunity, inflammation and disease·2019

This study found that people with severe asthma report many symptoms beyond breathing problems—such as fatigue, pain, and digestive issues—that are very similar to symptoms seen in fibromyalgia and chronic fatigue syndrome. The researchers compared symptom patterns between asthma patients and people with various functional disorders, finding that asthma and fibromyalgia symptoms were 75% similar in type and pattern. This suggests these conditions may share common underlying mechanisms related to how the body's systems interact.

Deconstructing post-exertional malaise: An exploratory factor analysis.

McManimen, Stephanie L, Sunnquist, Madison L, Jason, Leonard A·Journal of health psychology·2019

This study looked at post-exertional malaise (PEM)—the worsening of symptoms that happens after physical activity in ME/CFS—to understand whether it is one unified experience or two different types. The researchers found that PEM actually consists of two separate experiences: a whole-body fatigue and a muscle-specific fatigue. This suggests that PEM is more complex than previously thought and may need to be understood as having distinct components.

E2 ModerateBehavioralPEM not requiredCase-Control

Depressive symptoms in adolescents with chronic fatigue syndrome (CFS): Are rates higher than in controls and do depressive symptoms affect outcome?

Loades, Maria Elizabeth, Rimes, Katharine A, Ali, Sheila et al.·Clinical child psychology and psychiatry·2019

This study compared depression symptoms in adolescents with ME/CFS to healthy teenagers and teenagers with asthma. Young people with ME/CFS had significantly higher depression scores than both groups. While depression symptoms were linked to some worsening of fatigue over time, they were a stronger predictor of future depression itself, suggesting depression may be a separate concern that needs its own treatment approach.

E2 ModerateCohortPEM not requiredCross-Sectional

Associations Between Autonomic and Orthostatic Self-report and Physician Ratings of Orthostatic Intolerance in Youth.

Schultz, Katlin R, Katz, Ben Z, Bockian, Neil R et al.·Clinical therapeutics·2019

This study looked at whether what young people with ME/CFS report feeling about dizziness and heart symptoms matches what doctors measure during physical exams. Researchers compared answers from questionnaires with actual measurements of blood pressure and heart rate changes. They found that while patients reported these symptoms, the physical measurements didn't always show the same problems, suggesting current testing methods may miss real autonomic problems in young ME/CFS patients.

Autonomic Nervous System

E2 ModerateCohortPEM unclearLongitudinal

The Impact of a Structured Exercise Programme upon Cognitive Function in Chronic Fatigue Syndrome Patients.

Zalewski, Paweł, Kujawski, Sławomir, Tudorowska, Malwina et al.·Brain sciences·2019

This study tested whether a 16-week structured exercise program could help improve 'brain fog' and thinking problems that many people with ME/CFS experience. Of 53 patients who started the program, 34 completed it. Tests showed that those who finished the program had modest improvements in attention and processing speed, particularly in how quickly and accurately they could respond to visual tasks.

Cognitive Impairment

Systemic exertion intolerance disease/chronic fatigue syndrome is common in sleep centre patients with hypersomnolence: A retrospective pilot study.

Maness, Caroline, Saini, Prabhjyot, Bliwise, Donald L et al.·Journal of sleep research·2019

This study looked at people visiting sleep clinics who reported excessive daytime sleepiness and found that 21% of them also met criteria for ME/CFS (systemic exertion intolerance disease). People with both conditions reported more severe fatigue and were less likely to benefit from standard wake-promoting medications compared to those with only sleep disorders. The findings suggest that ME/CFS frequently occurs alongside sleep disorders and may make treatment more difficult.

E2 ModerateCohortPEM requiredObservational

Post-Exertional Malaise Is Associated with Hypermetabolism, Hypoacetylation and Purine Metabolism Deregulation in ME/CFS Cases.

McGregor, Neil R, Armstrong, Christopher W, Lewis, Donald P et al.·Diagnostics (Basel, Switzerland)·2019

This study looked at what happens in the body during post-exertional malaise (PEM)—the exhaustion and worsening of symptoms that ME/CFS patients experience after physical or mental activity. Researchers measured chemical changes in blood and urine over 7 days in 35 ME/CFS patients who reported PEM and compared them to healthy controls. They found that during PEM, the body shows signs of increased metabolism (burning energy faster), low levels of a molecule called hypoxanthine, and problems with how cells use and process energy, along with evidence that the body is breaking down muscle protein.

E2 ModerateMechanismPEM not requiredMechanistic

Treatment Avenues in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Split-gender Pharmacogenomic Study of Gene-expression Modules.

Jeffrey, Mary G, Nathanson, Lubov, Aenlle, Kristina et al.·Clinical therapeutics·2019

Researchers studied blood samples from 33 ME/CFS patients and 21 healthy people to look for differences in how their genes were working. They found that ME/CFS appears to involve problems with the immune system (the body's defense mechanism) and how cells produce energy. By matching these gene differences with existing FDA-approved drugs, they identified immunosuppressant medications as potential candidates that might help reduce ME/CFS symptoms.

E2 ModerateBehavioralPEM not requiredCross-Sectional

Depression, evening salivary cortisol and inflammation in chronic fatigue syndrome: A psychoneuroendocrinological structural regression model.

Milrad, Sara F, Hall, Daniel L, Jutagir, Devika R et al.·International journal of psychophysiology : official journal of the International Organization of Psychophysiology·2018

This study examined how depression, stress hormone levels, and inflammation connect in ME/CFS patients. Researchers found that people with ME/CFS who had higher evening cortisol (a stress hormone) levels also had more depression and higher levels of inflammatory markers in their blood. The results suggest that depression, hormones, and the immune system may be interconnected in ME/CFS, though more research is needed to understand which causes which.

E2 ModerateBehavioralPEM not requiredObservational

A 4-Day Mindfulness-Based Cognitive Behavioral Intervention Program for CFS/ME. An Open Study, With 1-Year Follow-Up.

Stubhaug, Bjarte, Lier, Haldis O, Aßmus, Jörg et al.·Frontiers in psychiatry·2018

This study tested whether a 4-day treatment program combining education, cognitive therapy, mindfulness, physical activity, and writing could help people with ME/CFS. Over 300 patients participated and were followed for one year. About 80% of patients showed meaningful improvement in fatigue and physical functioning that lasted throughout the year, and nearly all patients were satisfied with the program.

E2 ModerateCohortPEM not requiredCross-Sectional

Characteristics and determinants of dietary intake and physical activity in a group of patients with multiple chemical sensitivity.

Aguilar-Aguilar, Elena, Marcos-Pasero, Helena, de la Iglesia, Rocío et al.·Endocrinologia, diabetes y nutricion·2018

This study looked at the eating habits and exercise levels of 52 people with multiple chemical sensitivity (MCS), a condition where people react badly to everyday chemicals. The researchers found that most patients weren't eating enough fruits, vegetables, and dairy products, were taking many supplements, and very few were exercising regularly. The study suggests that better nutritional guidance tailored to each person's needs could help improve their health and quality of life.