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ME/CFS Atlas — A public knowledge atlas for ME/CFS

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ME/CFS Atlas is an evidence reference platform, not a medical provider. Content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

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ME/CFS Evidence Browser — Classified Studies on Myalgic Encephalomyelitis

Evidence browser

Search and filter 6,145 studies by evidence level, diagnostic criteria, PEM status, and research domain. Each entry links to the original source.

Studies sorted by evidence level, then year. Browse by topic instead →

Evidence level (E0–E3) reflects study type and replication, not methodological quality. A weak systematic review still sits at E0. How evidence levels work →

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510 studies

E0 — Consensus637E1 — Replicated320E2 — Moderate2,768E3 — Preliminary2,420

ME/CFS4,014Long COVID212Post-infectious189Overlapping1,045

Required for diagnosis412Not specified / unclear2,201Not required3,532

Post-Exertional Malaise1,055Cognitive Dysfunction1,723Pain1,612Unrefreshing Sleep793Orthostatic Intolerance474

Cytokines816Gene Expression567Metabolomics469Neuroimaging466Autoantibodies457

Infection-Triggered1,170Long COVID Overlap580Pediatric492Severe228

Strong Phenotyping435Sex-Stratified326Severe ME Included116

Systematic Review263Meta-Analysis60RCT300

Peer-reviewed6,088Preprint3Unclear54

301–320 of 510 studies

E3 PreliminaryReviewPEM unclearReview-Narrative

Neurasthenia: tracing the journey of a protean malady.

Bhola, Poornima, Chaturvedi, Santosh K·International review of psychiatry (Abingdon, England)·2020

This article traces the history of 'neurasthenia,' an old medical diagnosis meaning nervous exhaustion that was popular in the past but has largely disappeared from modern medicine. The authors explain how this diagnosis reflected the culture, biases, and social beliefs of its time, and how similar conditions today—like ME/CFS and fibromyalgia—are trying to describe the same patient experience of fatigue, pain, and weakness without clear medical causes.

E3 PreliminaryDiagnosticPEM unclearMethods-Paper

The development of a short form of the DePaul Symptom Questionnaire.

Sunnquist, Madison, Lazarus, Savitri, Jason, Leonard A·Rehabilitation psychology·2019

Researchers created a shorter version of a commonly used questionnaire that measures ME/CFS symptoms. Instead of 99 questions, the new version has only 14 questions that capture the most important symptoms. This shorter form works well at identifying people with ME/CFS and can be easier for patients to complete, especially those with fatigue and thinking difficulties.

E3 PreliminaryCommentaryPEM not required

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: Definitions, Similarities, and Differences.

Natelson, Benjamin H·Clinical therapeutics·2019

This article examines whether ME/CFS and fibromyalgia are the same illness or two different conditions. The author reviews existing research and concludes that while these conditions share some similarities, they appear to be distinct illnesses with different underlying causes. If they truly are different, it would mean doctors may eventually need different treatment approaches for each condition.

E3 PreliminaryCommentaryPEM unclearEditorial

Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses, and Medical Uncertainty.

Bransfield, Robert C, Friedman, Kenneth J·Healthcare (Basel, Switzerland)·2019

Doctors often struggle to distinguish between illnesses caused by psychological factors, illnesses where physical symptoms cause psychological effects, true multisystem diseases (affecting many body systems), and situations where medical causes haven't been found yet. This article discusses how using outdated or inaccurate diagnostic labels—like 'all in your head'—can harm patients and delay proper diagnosis. The authors argue that many conditions previously thought to be purely psychological may actually involve the immune system and microbiome, and that doctors need better training to avoid misdiagnosing complex diseases like ME/CFS.

E3 PreliminaryDiagnosticPEM unclearMethods-Paper

Approaching recovery from myalgic encephalomyelitis and chronic fatigue syndrome: Challenges to consider in research and practice.

Devendorf, Andrew R, Jackson, Carly T, Sunnquist, Madison et al.·Journal of health psychology·2019

This study interviewed 13 doctors who treat ME/CFS to understand the challenges they face when trying to measure whether patients are getting better. The researchers found four main areas that make recovery difficult to assess: differences in how the illness affects people at different ages, the fact that ME/CFS shows up differently in different patients, trouble keeping track of patients over time, and practical difficulties in measuring improvement.

InterventionsDiagnostics

E3 PreliminaryReviewPEM unclearReview-Narrative

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review.

Cortes Rivera, Mateo, Mastronardi, Claudio, Silva-Aldana, Claudia T et al.·Diagnostics (Basel, Switzerland)·2019

ME/CFS is a serious, long-lasting illness that affects the brain and causes extreme fatigue and other symptoms, but doctors don't yet know what causes it. The condition is three times more common in women than men, usually starts between ages 20 and 45, and currently has no specific cure. This review summarizes what scientists know about ME/CFS by looking at how it affects the nervous system, immune system, and hormones.

E3 PreliminaryReviewPEM unclearReview-Narrative

Neurasthenia: Modern Malady or Historical Relic?

Overholser, James C, Beale, Eleanor E·The Journal of nervous and mental disease·2019

This article looks back at a condition called neurasthenia that doctors diagnosed frequently between 1869 and 1930, then largely abandoned. The authors found that many symptoms people with neurasthenia experienced—like exhaustion, mental fog, and physical weakness—are still seen today in conditions like chronic fatigue syndrome (ME/CFS) and fibromyalgia. By understanding neurasthenia's history, modern doctors may better recognize and treat these conditions and improve how they listen to their patients.

E3 PreliminaryReviewPEM unclearReview-Narrative

Differential diagnosis between "chronic fatigue" and "chronic fatigue syndrome".

Son, Chang-Gue·Integrative medicine research·2019

This article discusses the important difference between regular chronic fatigue (long-lasting tiredness) and Chronic Fatigue Syndrome (ME/CFS), a serious medical condition. The author explains why it's crucial to distinguish between these two conditions, since ME/CFS involves specific symptoms and has different causes than simple persistent tiredness.

E3 PreliminaryCohortPEM unclearCase-Control

Varied Presentation of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and the Needs for Classification and Clinician Education: A Case Series.

Martín-Martínez, Eva, Martín-Martínez, Mercedes·Clinical therapeutics·2019

This study looked at three individual ME/CFS patient cases to understand why this disease presents so differently from person to person. The researchers found that patients often wait years for a correct diagnosis because many doctors don't understand ME/CFS well, leading to misdiagnosis and delays in treatment. The study suggests that organizing patient information carefully could help doctors and researchers identify different subtypes of ME/CFS.

E3 PreliminaryReviewPEM unclearReview-Narrative

Impact of Polypharmacy on Candidate Biomarker miRNomes for the Diagnosis of Fibromyalgia and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Striking Back on Treatments.

Almenar-Pérez, Eloy, Sánchez-Fito, Teresa, Ovejero, Tamara et al.·Pharmaceutics·2019

This study looked at how medicines commonly taken by fibromyalgia and ME/CFS patients might interfere with blood tests that could help diagnose these conditions. The researchers found that many prescription drugs can affect small molecules in the body called microRNAs, which are being studied as potential diagnostic markers. This means that when researchers try to identify disease-specific biomarkers, they may be picking up drug effects instead of actual disease signatures.

E3 PreliminaryDiagnosticPEM unclearMethods-Paper

The Development of the DePaul Symptom Questionnaire: Original, Expanded, Brief, and Pediatric Versions.

Jason, Leonard A, Sunnquist, Madison·Frontiers in pediatrics·2018

Researchers created a questionnaire called the DePaul Symptom Questionnaire (DSQ) to help doctors and scientists consistently measure ME/CFS symptoms in patients. The questionnaire was refined over time and adapted for different groups, including children. This tool helps ensure that when people are diagnosed with ME/CFS, they're being assessed in the same way across different clinics and studies.

E3 PreliminaryDiagnosticPEM not requiredMethods-Paper

Development and Validation of a Serologic Test Panel for Detection of Powassan Virus Infection in U.S. Patients Residing in Regions Where Lyme Disease Is Endemic.

Thomm, Angela M, Schotthoefer, Anna M, Dupuis, Alan P et al.·mSphere·2018

This study developed and tested a new blood test to detect Powassan virus, a tick-borne infection that can cause serious neurological problems. The test uses two steps: first screening with one method, then confirming positive results with a more specific test. The researchers found the test was accurate and could identify Powassan infections in patients living in areas where Lyme disease is common, suggesting this virus may be more prevalent than previously recognized.

E3 PreliminaryGuidelinePEM requiredGuideline

[Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome].

Kuratsune, Hirohiko·Brain and nerve = Shinkei kenkyu no shinpo·2018

This document presents official diagnostic criteria for ME/CFS developed by Japanese health authorities in 2016. These criteria were designed to help doctors in primary care clinics recognize and diagnose ME/CFS more consistently. The document also summarizes current treatment approaches and expected outcomes based on practices at major medical centers in Japan.

E3 PreliminaryReviewPEM unclearReview-Narrative

The biopolitics of CFS/ME.

Karfakis, Nikos·Studies in history and philosophy of biological and biomedical sciences·2018

This paper examines how ME/CFS is shaped by different groups—doctors, scientists, government officials, and patients themselves—who all try to define and understand the illness. The author shows that ME/CFS sits uncomfortably between medical and psychiatric explanations, which makes it hard for everyone to agree on what it is and how to treat it. Patients aren't just passive recipients of medical care; they actively educate themselves and push back against explanations they disagree with, which influences how the illness is understood.

E3 PreliminaryReviewPEM unclearReview-Narrative

Challenges in fibromyalgia diagnosis: from meaning of symptoms to fibromyalgia labeling.

Bidari, Ali, Ghavidel Parsa, Banafsheh, Ghalehbaghi, Babak·The Korean journal of pain·2018

Fibromyalgia (FM) is difficult to diagnose because there is no clear dividing line between having FM and not having it. This review examines why doctors and patients struggle with FM diagnosis, including how symptoms vary between people and over time, and how cultural and emotional factors influence whether a doctor labels someone as having FM. The authors argue that doctors' judgment based on talking with patients may be more reliable than relying only on scoring systems.

E3 PreliminaryGuidelinePEM unclearGuideline

Dutch Health Council Advisory Report on Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: Taking the Wrong Turn.

Twisk, Frank·Diagnostics (Basel, Switzerland)·2018

The Dutch Health Council released an official report recognizing ME/CFS as a serious, multi-system disease rather than primarily a psychological condition. The report recommends establishing specialized medical centers, training doctors better about ME/CFS, and improving how disability benefits are assessed for patients. However, the report's new definition of ME/CFS may create unintended problems for future research and patient care.

E3 PreliminaryCommentaryPEM unclearEditorial

[Environmental medical syndromes].

Wiesmüller, Gerhard A, Hornberg, Claudia·Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz·2017

This editorial discusses several conditions that seem related to environmental exposures and stress, including ME/CFS, fibromyalgia, and multiple chemical sensitivities. The authors explain that we don't yet fully understand what causes these conditions or how to diagnose and treat them properly. They emphasize that doctors should take patients seriously and help them even while research continues to find answers.

E3 PreliminaryReviewPEM unclearReview-Narrative

Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome.

Blease, Charlotte, Carel, Havi, Geraghty, Keith·Journal of medical ethics·2017

Many doctors are uncertain whether ME/CFS is a real medical condition, and some patients report feeling disbelieved or suspected by healthcare providers. This study shows that patients with ME/CFS often experience unfair treatment in medical settings because doctors may not take their symptoms seriously. This type of dismissal—called epistemic injustice—can delay diagnosis and proper care for people with this serious illness.

E3 PreliminaryCohortPEM unclear

A woman in her 50s with chronic fatigue syndrome, sepsis and hyponatraemia.

Tazmini, Kiarash, Meling, Torstein R, Skattør, Thor Håkon et al.·Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke·2017

This case report describes a woman in her 50s with ME/CFS who developed a serious blood infection (sepsis) and low sodium levels in her blood. The doctors documented her medical history and response to treatment. This single case highlights how ME/CFS patients can develop additional serious medical complications that require careful monitoring and treatment.

E3 PreliminaryPEM not required

Exploring the potential role of the advanced nurse practitioner within a care path for patients with chronic fatigue syndrome.

Ryckeghem, Hannah, Delesie, Liesbeth, Tobback, Els et al.·Journal of advanced nursing·2017

This study asked ME/CFS patients and their doctors in Belgium what they thought about their care. Both groups reported feeling isolated and unsupported—patients didn't know who to turn to for reliable information, and doctors weren't sure how to help. The researchers suggest that having a specialized nurse coordinator could improve communication, provide education, and help different healthcare providers work together better for ME/CFS patients.

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Or browse by topic

PEM Immune Neuro Metabolic Biomarkers Severe ME Long COVID Cognitive

Curated Collections

Thematic groupings by clinical question or research area.

Neuroinflammation Evidence

PET imaging and other studies providing evidence for brain inflammation in ME/CFS.

Metabolism & Mitochondria

Metabolomics and mitochondrial function studies revealing energy metabolism disruption.

Biomarkers

Studies identifying potential biological markers for ME/CFS diagnosis and stratification.

PEM-Specific Research

Studies specifically examining post-exertional malaise, the hallmark symptom of ME/CFS.