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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 6,167 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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517 studies

E0 — Consensus643E1 — Replicated320E2 — Moderate2,782E3 — Preliminary2,422

ME/CFS4,025Long COVID217Post-infectious189Overlapping1,050

Required for diagnosis414Not specified / unclear2,219Not required3,534

Post-Exertional Malaise1,064Cognitive Dysfunction1,735Pain1,620Unrefreshing Sleep799Orthostatic Intolerance478

Cytokines818Gene Expression567Metabolomics473Neuroimaging468Autoantibodies458

Infection-Triggered1,174Long COVID Overlap588Pediatric493Severe231

Strong Phenotyping438Sex-Stratified326Severe ME Included118

Systematic Review265Meta-Analysis60RCT300

Peer-reviewed6,110Preprint3Unclear54

321–340 of 517 studies

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 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 PreliminaryCohortPEM unclearCross-Sectional

"It´s incredible how much I´ve had to fight." Negotiating medical uncertainty in clinical encounters.

Lian, Olaug S, Robson, Catherine·International journal of qualitative studies on health and well-being·2017

This study asked 256 people with long-term unexplained fatigue in Norway to describe their experiences with doctors. Most patients felt their doctors didn't believe them, gave unhelpful psychological explanations, didn't do proper physical exams, and didn't listen to what they knew about their own condition. Patients described these encounters using words like 'fighting' and 'war,' showing how stressful and adversarial these medical visits felt.

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.

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 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 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 PreliminaryReviewPEM unclearReview-Narrative

Severity Scales for Use in Primary Health Care to Assess Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

Hardcastle, Sharni Lee, Brenu, Ekua Weba, Johnston, Samantha et al.·Health care for women international·2016

ME/CFS affects people very differently—some have mild symptoms while others are severely disabled. This study reviewed different tools doctors can use to measure how severe a patient's ME/CFS is based on their symptoms and ability to function physically and mentally. Using these measurement tools helps doctors and researchers identify different groups of ME/CFS patients, which could lead to better diagnosis and treatment.

E3 PreliminaryDiagnosticPEM unclearCross-Sectional

Assessing current functioning as a measure of significant reduction in activity level.

Thorpe, Taylor, McManimen, Stephanie, Gleason, Kristen et al.·Fatigue : biomedicine, health & behavior·2016

ME/CFS diagnosis requires patients to show a significant drop in their activity levels, but doctors haven't agreed on how to measure this drop consistently. This study tested whether a common health survey (the SF-36) could accurately measure when someone's activities have substantially decreased. The researchers found that certain parts of this survey do a good job of identifying major reductions in functioning and can distinguish ME/CFS patients from healthy people.

E3 PreliminaryReviewPEM not requiredReview-Narrative

[Chronic fatifue syndrome.].

Holecek, V, Rokyta, R·Ceskoslovenska fysiologie·2016

This review article provides an overview of ME/CFS, explaining what it is, how common it is, and how doctors diagnose and treat it. The condition lasts about 6 months or longer in adults and at least 3 months in children, causing persistent fatigue and other symptoms. The article covers multiple possible causes including biological, genetic, infectious, and psychological factors, as well as the economic impact of the disease.

E3 PreliminaryCommentaryPEM unclearEditorial

Investigating unexplained fatigue in general practice with a particular focus on CFS/ME.

Bansal, Amolak S·BMC family practice·2016

This paper looks at how doctors in general practice can identify ME/CFS in patients who come in complaining of unexplained tiredness. The authors explain that ME/CFS is a real condition with specific diagnostic criteria, and that normal blood tests (ruling out infections, thyroid problems, and other common causes) combined with careful clinical assessment can confidently diagnose it. They argue that early diagnosis in primary care can reduce patient worry and prevent unnecessary, costly tests.

E3 PreliminaryReviewPEM not requiredReview-Narrative

Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties.

Ferré, A·Neurologia·2016

This review looked at the connection between ME/CFS and sleep problems. Many people with ME/CFS experience non-restorative sleep (where sleep doesn't feel refreshing) and fatigue, but these same symptoms can happen with other sleep disorders. The key finding is that doctors need to carefully check whether patients have a separate sleep disorder before or alongside an ME/CFS diagnosis, because treating the sleep problem might help improve overall quality of life.

SleepDiagnostics

E3 PreliminaryCohortPEM unclearCross-Sectional

Implementing resources to support the diagnosis and management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) in primary care: A qualitative study.

Bayliss, Kerin, Riste, Lisa, Band, Rebecca et al.·BMC family practice·2016

This study looked at whether special training and information resources for GPs could help them better diagnose and manage ME/CFS. Researchers interviewed patients and doctors in North West England and found that while the resources were helpful when used properly, most GPs didn't actually use them—either because they were too busy, didn't see enough ME/CFS patients to remember the training, or thought the condition should only be managed by specialists.

E3 PreliminaryReviewPEM not requiredReview-Narrative

Fibromyalgia: A Critical and Comprehensive Review.

Borchers, Andrea T, Gershwin, M Eric·Clinical reviews in allergy & immunology·2015

Fibromyalgia is a condition that causes widespread pain, fatigue, and sleep problems, and it shares many symptoms with other conditions that are hard to diagnose. This review explains that while some people think fibromyalgia might be caused by infection, inflammation, or injury, there is not strong evidence supporting these ideas. The authors recommend that treatment should focus on education, exercise, physical therapy, and approved medications rather than opioids.

Pain and SensitizationSleepDiagnostics

E3 PreliminaryCommentaryPEM unclearEditorial

Fibromyalgia and chronic fatigue syndrome: management issues.

Bourke, Julius·Advances in psychosomatic medicine·2015

This article discusses how fibromyalgia and ME/CFS are common conditions that were previously dismissed or not taken seriously by doctors, causing patients significant suffering. Recent scientific discoveries have improved our understanding of how these conditions work in the body and what treatments may help. While complete recovery is not common, moderate improvements in symptoms and quality of life are achievable with proper management.

E3 PreliminaryReviewPEM unclearReview-Narrative

Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness.

Military medicine·2015

This review article examines how ME/CFS is currently defined and proposes that our understanding of the illness needs to be updated. The authors, writing in a military medicine context, suggest that the condition extends beyond what the traditional name 'Myalgic Encephalomyelitis/Chronic Fatigue Syndrome' captures. The paper calls for a broader perspective on how this serious illness should be recognized and understood.

E3 PreliminaryDiagnosticPEM not requiredCross-Sectional

Complications in operationalizing lifelong fatigue as an exclusionary criterion.

Sunnquist, Madison, Jason, Leonard A, Brown, Abigail et al.·Journal of prevention & intervention in the community·2015

This study looked at whether people who have felt tired their whole lives should be excluded from ME/CFS diagnoses. Researchers asked patients detailed questions about lifelong fatigue and found it was very difficult to determine who truly had it. Importantly, people with and without lifelong fatigue had similar ME/CFS symptoms, suggesting this exclusion rule may not be helpful.

E3 PreliminaryCohortPEM not requiredCase-Control

Mitochondrial Myopathy in Follow-up of a Patient With Chronic Fatigue Syndrome.

Galán, Fernando, de Lavera, Isabel, Cotán, David et al.·Journal of investigative medicine high impact case reports·2015

This case study describes a patient who was initially diagnosed with chronic fatigue syndrome (CFS) but was later found to have a different condition called mitochondrial myopathy—a disease affecting the energy-producing structures in muscle cells. Testing showed the patient had severe deficiencies in certain components of these energy-producing structures, and genetic analysis revealed mutations inherited from the mother. The patient and family members improved significantly with high-dose vitamins B1 and B2.

E3 PreliminaryDiagnosticPEM unclearMethods-Paper

Test-Retest Reliability of the DePaul Symptom Questionnaire.

Jason, Leonard A, So, Suzanna, Brown, Abigail A et al.·Fatigue : biomedicine, health & behavior·2015

Researchers tested whether the DePaul Symptom Questionnaire (DSQ)—a tool designed to help doctors diagnose ME/CFS—gives consistent results when used multiple times. They asked 26 people with ME/CFS and 25 healthy people to answer the same questions at different times. The questionnaire proved reliable, meaning patients' answers were consistent, making it a trustworthy tool for identifying who has ME/CFS.

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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.