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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

481–500 of 517 studies

E3 PreliminaryReviewPEM not requiredReview-Narrative

[Definition of the chronic fatigue syndrome and its issues].

Hashimoto, N·Nihon rinsho. Japanese journal of clinical medicine·1992

This article reviews how ME/CFS was officially defined by the CDC in 1988 and identifies problems with that definition. The author points out that while the definition tries to rule out other conditions, it has trouble distinguishing ME/CFS from similar conditions like fibromyalgia and depression, and it's difficult to measure in real-world clinical practice.

E3 PreliminaryReviewPEM not requiredReview-Narrative

Chronic fatigue syndrome. Recent advances in diagnosis and treatment.

Bell, D S·Postgraduate medicine·1992

ME/CFS typically starts suddenly with severe tiredness and flu-like symptoms that come and go over months or years. While blood tests sometimes show immune system changes, doctors diagnose ME/CFS mainly by recognizing the pattern of symptoms and ruling out other illnesses. Current treatment focuses on managing symptoms and helping patients cope with this long-lasting, disabling condition.

InterventionsDiagnostics

E3 PreliminaryReviewPEM not requiredReview-Narrative

Chronic fatigue syndrome. A review from the general practice perspective.

Holmwood, C, Shannon, C·Australian family physician·1992

This 1992 editorial confirms that ME/CFS is a real condition that significantly impacts people's quality of life, though the exact cause was not yet known. The authors suggest that treatment should focus on supportive counseling, explanation of the condition, psychiatric support when needed, and gradually increasing activity levels to help people return to normal functioning.

E3 PreliminaryReviewPEM not requiredReview-Narrative

[Chronic fatigue syndrome--symptoms, signs, laboratory tests, and prognosis].

Kanayama, Y·Nihon rinsho. Japanese journal of clinical medicine·1992

This review article describes the main symptoms and characteristics of ME/CFS, including persistent fatigue lasting more than 6 months, low-grade fevers, swollen lymph nodes, muscle and joint pain, and mood-related symptoms. Since no specific blood test or scan can definitively diagnose ME/CFS, doctors must rule out other known causes of fatigue before making the diagnosis. The underlying cause remains unknown, though researchers suspect it may involve an infection combined with psychological factors.

E3 PreliminaryReviewPEM unclearReview-Narrative

[Chronic fatigue syndrome: the present concept and historical perspective].

Kitani, T·Nihon rinsho. Japanese journal of clinical medicine·1992

This is an editorial article that reviews what ME/CFS (chronic fatigue syndrome) is and how our understanding of it has changed over time. The author examines the current definition of ME/CFS and discusses its history, helping readers understand how medical perspectives on this illness have evolved.

E3 PreliminaryDiagnosticPEM not requiredMethods-Paper

[Diagnostic criteria for chronic fatigue syndrome by the CFS Study Group in Japan].

Kitani, T, Kuratsune, H, Yamaguchi, K·Nihon rinsho. Japanese journal of clinical medicine·1992

In 1992, Japanese researchers created new diagnostic guidelines to help doctors identify ME/CFS in their patients. These guidelines were based on earlier American standards but included some modifications, such as defining less severe cases and recognizing a form that develops after infections.

E3 PreliminaryCommentaryPEM not requiredEditorial

Neuro-ocular Lyme borreliosis.

Smith, J L·Neurologic clinics·1991

This study suggests that some patients diagnosed with chronic fatigue syndrome (CFS) might actually have Lyme disease, a tick-borne infection that can affect the brain and eyes. The authors recommend doctors ask CFS patients detailed questions about tick exposure and check for specific eye and neurological problems, then use blood and urine tests to look for evidence of Lyme infection.

E3 PreliminaryCommentaryPEM unclearEditorial

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.

Goldenberg, D L·Current opinion in rheumatology·1991

This review examines three related conditions—fibromyalgia, chronic fatigue syndrome, and myofascial pain—that often occur together and cause pain, tiredness, and sleep problems. Researchers are discovering that these conditions may share common biological causes involving how the body senses pain, hormone imbalances, and problems with muscle function. Unfortunately, the new treatments being tested at that time were not particularly effective.

Pain and SensitizationSleepDiagnostics

E3 PreliminaryReviewPEM not requiredReview-Narrative

[Chronic fatigue: myth or reality?].

Comtois, R·L'union medicale du Canada·1991

This 1991 review article addresses a fundamental question: Is chronic fatigue a real medical condition or just a perception? The authors acknowledge that while fatigue is one of the most common health complaints doctors hear, it can be difficult to diagnose and treat because we don't have simple blood tests like we do for cholesterol. The paper discusses how new diagnostic criteria for chronic fatigue syndrome were beginning to help doctors identify and manage this condition more effectively.

E3 PreliminaryReviewPEM not requiredReview-Narrative

Evaluation and management of patients with chronic fatigue.

Matthews, D A, Manu, P, Lane, T J·The American journal of the medical sciences·1991

This review article examines how doctors diagnose and treat patients who experience chronic fatigue in everyday medical practice. The authors note that chronic fatigue has many possible causes, including medical illnesses, psychiatric conditions like depression and anxiety, lifestyle factors, and medications. They emphasize that building trust with patients and using a combination of psychiatric evaluation, functional assessment, and both medication and behavioral therapy approaches are important for effective care.

E3 PreliminaryCohortPEM unclearObservational

Clinical observations of chronic fatigue syndrome.

Mildon, C A·Canada diseases weekly report = Rapport hebdomadaire des maladies au Canada·1991

This 1991 study documents clinical observations of people with ME/CFS, describing what doctors noticed when examining patients with this condition. The report provides early descriptive information about how the illness presented in patients during that time period. While limited in scope, it contributes to the historical medical record of ME/CFS recognition.

E3 PreliminaryDiagnosticPEM not requiredMethods-Paper

Issues and problems in the conduct of epidemiologic research on chronic fatigue syndrome.

Grufferman, S·Reviews of infectious diseases·1991

This paper discusses how scientists should study ME/CFS using epidemiology—a research method that looks at how diseases spread through populations. The authors outline the main problems researchers face when studying ME/CFS, such as unclear diagnostic criteria and limited understanding of the condition, and suggest practical solutions. They emphasize that case-control studies (comparing people who have ME/CFS with similar people who don't) should be a priority for understanding what causes the illness.

E3 PreliminaryCommentaryPEM not requiredEditorial

Chronic fatigue syndrome: is it real?

Kroenke, K·Postgraduate medicine·1991

This 1991 editorial discusses what doctors understood about ME/CFS at that time. The author suggests that ME/CFS is likely connected to depression, mild immune system problems, or a combination of both, rather than being caused by Epstein-Barr virus alone. The article recommends that doctors use careful patient interviews, physical exams, and basic blood tests to diagnose the condition, and that supportive, hopeful care is important for treatment.

E3 PreliminaryDiagnosticPEM not requiredMethods-Paper

A supplemental interview for forms of "affective spectrum disorder".

Pope, H G, Hudson, J I·International journal of psychiatry in medicine·1991

Researchers created a standardized interview tool to help diagnose seven different conditions—including chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, migraines, narcolepsy, Tourette's disorder, and kleptomania—based on the idea that these disorders may be related to each other. They developed questions following a recognized medical interview format and tested the tool with over 100 patients. The authors suggest these conditions may share common underlying features related to mood and emotion regulation.

E3 PreliminaryReviewPEM not requiredReview-Narrative

Definition and measurement of fatigue.

Barofsky, I, Legro, M W·Reviews of infectious diseases·1991

This paper examines how fatigue is defined and measured in ME/CFS, highlighting that these definitions have not been well-developed in medical research. The authors reviewed different tools available to measure fatigue—ranging from simple single-item questions to more complex multi-part assessments—and discussed how fatigue in ME/CFS differs from fatigue studied in healthy people in laboratory settings. They emphasize the need to study fatigue as it actually occurs in patients with ME/CFS and to use consistent measurement methods across research.

E3 PreliminaryReviewPEM unclearReview-Narrative

Post-viral fatigue syndrome. Epidemiology: lessons from the past.

Jenkins, R·British medical bulletin·1991

This review examines the history of post-viral fatigue syndrome (PVFS), including early outbreaks of what we now call ME/CFS, and how doctors have understood and tracked this illness over time. The author notes that cases are not officially recorded by health authorities, making it hard to spot when the condition becomes more common in communities. The review explores important questions about how the illness is defined, why some people develop it after infections, and how psychological factors relate to the physical symptoms.

E3 PreliminaryCommentaryPEM not requiredEditorial

[Chronic fatigue syndrome].

Ewig, S, Dengler, H J·Klinische Wochenschrift·1990

This paper discusses chronic fatigue syndrome (CFS) as a condition that can develop after viral infections like Epstein-Barr virus or Coxsackie-B virus. Researchers noted that CFS may actually be several different diseases with different causes rather than one single condition. The authors emphasize that diagnosis requires ruling out other medical conditions first, and that at this time, we don't have enough knowledge to recommend specific treatments.

E3 PreliminaryCommentaryPEM not requiredEditorial

[Chronic fatigue syndrome--a new disease picture?].

Nix, W A·Der Nervenarzt·1990

This editorial from 1990 discusses that ME/CFS was becoming more commonly diagnosed at that time, but doctors weren't sure if it was one distinct disease or simply a label given to many different conditions. The author notes that we still need to understand whether ME/CFS has a physical cause, a psychological cause, or both, and that each patient may need individual evaluation.

E3 PreliminaryReviewPEM unclearReview-Narrative

Old wine in new bottles: neurasthenia and 'ME'.

Wessely, S·Psychological medicine·1990

This paper compares ME/CFS with an older condition called neurasthenia that was common in the late 1800s and early 1900s. Both illnesses share similar symptoms of extreme fatigue and were popular diagnoses when people believed they were caused by physical (not mental) problems and affected successful, hardworking people. The author argues that understanding ME/CFS requires looking at both brain biology and social factors, not just one or the other.

E3 PreliminaryReviewPEM unclearReview-Narrative

[Chronic fatigue syndrome, fibromyalgia and depression].

Martin-Du-Pan, R·Revue medicale de la Suisse romande·1990

This 1990 review article examines the relationships between chronic fatigue syndrome (ME/CFS), fibromyalgia, and depression. The author discusses how these three conditions sometimes occur together and explores whether they share common features or causes. The paper helps clarify how ME/CFS and fibromyalgia are distinct from depression, even though all three can cause fatigue and other overlapping symptoms.

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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.