Evidence browser

Improvement in Upper Limb and Systemic Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Symptoms After Surgical Treatment of Neurogenic Thoracic Outlet Syndrome.

Christoforou, Maritsa E, Lum, Ying Wei, Sroge, Sally C et al.·Cureus·2025

This case study describes a 19-year-old woman with ME/CFS who also had a condition called thoracic outlet syndrome (TOS), where nerves in the upper chest become compressed. After surgery to relieve this compression on both sides of her body, she experienced not only relief from arm numbness and tingling, but also surprising improvements in migraines, brain fog, dizziness, and vision problems. This suggests that some ME/CFS patients might benefit from being evaluated for TOS, as treating it could potentially help with multiple symptoms.

[Modern approaches to diagnosis and treatment of postinfectious asthenic syndrome in children].

Nemkova, S A·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2025

This review article discusses postinfectious asthenic syndrome—a condition causing severe tiredness and weakness that develops after infections like colds, flu, and COVID-19 in children and teenagers. The authors examine how this condition develops, its symptoms, and how a medication called Mexidol may help reduce fatigue and improve thinking, mood, and nervous system problems that often accompany it.

E3 PreliminaryReviewPEM not requiredReview-Narrative

The interplay between Sars-Cov-2 infection related cardiovascular diseases and depression. Common mechanisms, shared symptoms.

Gonjilashvili, Ana, Tatishvili, Sophio·American heart journal plus : cardiology research and practice·2024

This review examines how COVID-19 can affect both the heart and mental health, and why these problems often occur together. The authors explain that inflammation, unhealthy lifestyle changes, and communication between organs may all play a role. They note that long COVID shares many symptoms with heart and brain problems—like fatigue, brain fog, dizziness, chest pain, and depression—which is why patients need care from multiple medical specialists.

Dysautonomia following Lyme disease: a key component of post-treatment Lyme disease syndrome?

Adler, Brittany L, Chung, Tae, Rowe, Peter C et al.·Frontiers in neurology·2024

This review examines how Lyme disease can damage the autonomic nervous system—the part of your nervous system that controls automatic body functions like heart rate, blood pressure, and digestion. The authors argue that this autonomic dysfunction may explain why some people with Lyme disease develop persistent, widespread symptoms similar to those seen in ME/CFS and long COVID. They review existing evidence and propose possible mechanisms for how the Lyme disease bacteria might cause these ongoing problems.

E3 PreliminaryGuidelinePEM unclearGuideline

Improving quality in adult long covid services: Findings from the LOCOMOTION quality improvement collaborative.

Darbyshire, Julie, Greenhalgh, Trisha, Bakerly, Nawar D et al.·Clinical medicine (London, England)·2024

This study looked at how ten long COVID clinics across the UK could improve their care for patients by sharing what they were learning with each other. From 2021 to 2023, clinic staff and patients met regularly to discuss the best ways to help people with long COVID, focusing on problems like breathing difficulties, heart rate issues, tiredness, and brain fog. The team created practical guides to help doctors provide better, more consistent care.

E3 PreliminaryMechanismPEM unclearObservational

Head-down tilt reduces the heart rate in postural tachycardia syndrome in acute setting: a pilot study.

Novak, Peter·Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·2024

This small study tested whether tilting the head downward slightly could help people with POTS (a condition causing rapid heart rate when standing). Researchers found that a 10-degree head-down tilt for 2 minutes safely reduced heart rate by about 10% and improved blood oxygen levels. Four of the seven patients tested also had ME/CFS, suggesting this approach might have potential for multiple related conditions.

E3 PreliminaryReviewPEM not requiredReview-Narrative

Cardiac Geometry and Function in Patients with Reflex Syncope.

Coseriu, Giorgia, Schiop-Tentea, Patricia, Apetrei, Csilla-Andrea et al.·Journal of clinical medicine·2024

This review examines how the size and function of the heart relate to fainting episodes in people with reflex syncope. Researchers found that people with smaller hearts and very forceful heartbeats are more prone to fainting, and this pattern is also seen in some people with chronic fatigue syndrome. Understanding these heart differences may help doctors predict who will faint again and choose better treatments.

E3 PreliminaryCohortPEM not required

Stress-Related Chronic Fatigue Syndrome: A Case Report with a Positive Response to Alpha-Methyl-P-Tyrosine (AMPT) Treatment.

Ljungström, Maria, Oltra, Elisa, Pardo, Marta·International journal of molecular sciences·2024

This case report describes one patient with ME/CFS who had high levels of stress and an overactive stress-response system in his body. He was treated with a medication called alpha-methyl-p-tyrosine (AMPT), which lowers stress chemicals in the body, and his symptoms improved. The report suggests that some people with ME/CFS may have problems with how their body produces and manages stress chemicals, and this medication might help them.

E3 PreliminaryMechanismPEM not requiredLongitudinal

Time-dependent complexity characterisation of activity patterns in patients with Chronic Fatigue Syndrome.

Rabaey, Paloma, Decat, Peter, Heytens, Stefan et al.·BioPsychoSocial medicine·2024

Researchers tracked the physical activity patterns of 7 ME/CFS patients over 3 weeks to see if the complexity of how they move changes over time and relates to how well they're functioning. They found that each patient's activity complexity varied significantly from week to week, and these changes didn't consistently match whether patients reported feeling better or worse. This suggests that measuring activity patterns alone may not be a reliable way to track how ME/CFS patients are doing.

E3 PreliminaryCommentaryPEM requiredEditorial

Post-exertional malaise in daily life and experimental exercise models in patients with myalgic encephalomyelitis/chronic fatigue syndrome.

Vøllestad, Nina K, Mengshoel, Anne Marit·Frontiers in physiology·2023

This paper reviews how post-exertional malaise (PEM)—the worsening of symptoms after physical or mental activity—is experienced and studied in ME/CFS patients. Patients describe PEM in many different ways and report that it can start immediately or be delayed by days, lasting anywhere from a few days to months. When researchers use standardized exercise tests in laboratories, they see more immediate symptom worsening, but the duration still varies widely between patients.

Autonomic Nervous SystemPost-Exertional Malaise

A Case Study of Successful Application of the Principles of ME/CFS Care to an Individual with Long COVID.

Petracek, Lindsay S, Broussard, Camille A, Swope, Renee L et al.·Healthcare (Basel, Switzerland)·2023

A 19-year-old developed severe ME/CFS-like symptoms after COVID-19 infection. Doctors used ME/CFS treatment approaches—including physical therapy, heart rate monitoring, and medications for heart and immune problems—and the patient improved significantly over 2.5 years. This case suggests that treatments developed for ME/CFS may also help some long COVID patients.

Cardiovascular and haematological pathology in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A role for viruses.

Nunes, Jean M, Kell, Douglas B, Pretorius, Etheresia·Blood reviews·2023

This review examines how the heart, blood vessels, and blood clotting system may be affected in ME/CFS. Research shows that ME/CFS patients often have problems with blood flow to the brain, abnormal blood clotting, and damaged blood vessel linings—similar to what happens in Long COVID. These cardiovascular and blood abnormalities may contribute to ME/CFS symptoms and could potentially become targets for new treatments.

E3 PreliminaryPEM unclear

Converging Evidence of Similar Symptomatology of ME/CFS and PASC Indicating Multisystemic Dyshomeostasis.

Marks, David F·Biomedicines·2023

This study found that ME/CFS and long COVID (PASC) cause very similar symptoms in patients. Researchers compared symptom reports from two groups and found they matched about 90% of the time. The authors suggest both conditions may involve the body's control systems (nervous system, hormones, and immune system) getting stuck in a broken state, similar to a thermostat that can't turn off.

Case report: Recurrent cervical spinal stenosis masquerading as myalgic encephalomyelitis/chronic fatigue syndrome with orthostatic intolerance.

Edwards, Charles C, Edwards, Charles C, Heinlein, Scott et al.·Frontiers in neurology·2023

This case report describes a woman who was thought to have ME/CFS and experienced symptoms of dizziness upon standing (orthostatic intolerance). Doctors discovered she actually had cervical spinal stenosis—a narrowing of the spinal canal in her neck that was compressing her spinal cord. After surgery to relieve the compression, her ME/CFS and orthostatic intolerance symptoms improved significantly. Years later, her symptoms returned because the surgical implant shifted, compressing the spinal cord again. A second surgery provided similar improvement, suggesting that spinal stenosis may have been causing or worsening her ME/CFS symptoms rather than the other way around.

E3 PreliminaryReviewPEM not requiredReview-Narrative

A Review of Stellate Ganglion Block as an Adjunctive Treatment Modality.

Kirkpatrick, Kennedy, Khan, Mashfee H, Deng, Yi et al.·Cureus·2023

This review article explores a procedure called stellate ganglion block (SGB), where doctors inject local anesthetic into nerve bundles in the neck to calm an overactive nervous system. The authors suggest that several conditions—including chronic fatigue syndrome, long-COVID, and loss of smell—may share a common problem: too much sympathetic nervous system activity (the 'fight or flight' response). Early case reports suggest SGB might help patients with these conditions when standard treatments don't work, though more research is needed.

Narrative Review of Postural Orthostatic Tachycardia Syndrome: Associated Conditions and Management Strategies.

Steinberg, Rebecca S, Dicken, Weston, Cutchins, Alexis·US cardiology·2023

This review examines POTS (Postural Orthostatic Tachycardia Syndrome), a condition where your heart rate jumps too quickly when you stand up, along with other symptoms like dizziness and fatigue. The authors combined research evidence with their clinical experience to explain how POTS is recognized, what other conditions often occur alongside it, and how doctors can treat it. Many patients and doctors find POTS frustrating to diagnose and manage because treatments haven't been well-studied and POTS shares symptoms with other conditions.

Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers.

Petracek, Lindsay S, Eastin, Ella F, Rowe, Ian R et al.·BMC sports science, medicine & rehabilitation·2022

This study looked at five elite swimmers who experienced severe fatigue and couldn't perform at their usual level. The researchers tested whether orthostatic intolerance—a condition where the body struggles to maintain proper blood pressure when standing—might explain their symptoms. When the swimmers were tested with standing or tilt table tests, they all felt fatigued and other symptoms appeared. After receiving treatment with extra salt and fluids, all five swimmers felt significantly better and returned to normal performance.

Autoimmune Autonomic Dysfunction Syndromes: Potential Involvement and Pathophysiology Related to Complex Regional Pain Syndrome, Fibromyalgia, Chronic Fatigue Syndrome, Silicone Breast Implant-Related Symptoms and Post-COVID Syndrome.

Mahroum, Naim, Shoenfeld, Yehuda·Pathophysiology : the official journal of the International Society for Pathophysiology·2022

This article suggests that several chronic conditions—including ME/CFS, fibromyalgia, long COVID, and complex regional pain syndrome—may share a common cause: the immune system mistakenly producing antibodies that attack the autonomic nervous system (the part of your body that controls automatic functions like heart rate and blood pressure). The authors propose calling these conditions "autoimmune autonomic dysfunction syndromes" to highlight this shared mechanism and potentially help doctors diagnose and treat them more effectively.

E3 PreliminaryMechanismPEM not requiredObservational

Changes in the Allostatic Response to Whole-Body Cryotherapy and Static-Stretching Exercises in Chronic Fatigue Syndrome Patients vs. Healthy Individuals.

Kujawski, Sławomir, Bach, Anna M, Słomko, Joanna et al.·Journal of clinical medicine·2021

This study compared how the bodies of ME/CFS patients and healthy people respond to cold therapy combined with stretching exercises. Researchers measured fatigue, thinking ability, heart function, and nervous system activity before and after 10 sessions of treatment. They found that ME/CFS patients showed more disrupted connections between these body systems compared to healthy controls, suggesting their bodies struggle more to maintain balance under stress.

E3 PreliminaryMechanismPEM not requiredMechanistic

Homeostatic disturbance of thermoregulatory functions in rats with chronic fatigue.

Li, Danxi, Hu, Di, Shigeta, Mika et al.·Neuroscience research·2021

Many ME/CFS patients report feeling feverish or chilled even when their body temperature is normal. This study used rats with chronic fatigue to understand what goes wrong with the body's temperature control system. Researchers found that in early fatigue, the body tried to raise its temperature to cope, but over time this system broke down and stopped working properly, which may explain why fatigue becomes long-lasting.