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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 6,121 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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200 studies

E0 — Consensus629E1 — Replicated319E2 — Moderate2,757E3 — Preliminary2,416

ME/CFS4,010Long COVID208Post-infectious188Overlapping1,031

Required for diagnosis409Not specified / unclear2,191Not required3,521

Post-Exertional Malaise1,040Cognitive Dysfunction1,712Pain1,606Unrefreshing Sleep787Orthostatic Intolerance470

Cytokines812Gene Expression564Metabolomics469Neuroimaging464Autoantibodies454

Infection-Triggered1,158Long COVID Overlap563Pediatric494Severe227

Strong Phenotyping427Sex-Stratified325Severe ME Included115

Systematic Review256Meta-Analysis60RCT299

Peer-reviewed6,064Preprint3Unclear54

61–80 of 200 studies

E1 ReplicatedTrialPEM not requiredRCT

Recovery from chronic fatigue syndrome after treatments given in the PACE trial.

White, P D, Goldsmith, K, Johnson, A L et al.·Psychological medicine·2013

This study looked at how many ME/CFS patients got better after receiving different treatments over one year. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) helped about 22% of patients recover, while adaptive pacing therapy and standard medical care alone helped only about 7-8%. CBT and GET were significantly more effective than the other treatments tested.

E1 ReplicatedTrialPEM not requiredRCT

Moderators of the treatment response to guided self-instruction for chronic fatigue syndrome.

Tummers, Marcia, Knoop, Hans, van Dam, Arno et al.·Journal of psychosomatic research·2013

This study looked at which ME/CFS patients benefit most from a self-guided treatment that focuses on changing thoughts and behaviors related to fatigue. Researchers found that younger patients, those without significant depression, and those who don't tend to avoid activities responded better to this treatment. Patients with severe depression or who are older may need different or additional types of help.

E1 ReplicatedTrialPEM unclearRCT

The feasibility and acceptability of conducting a trial of specialist medical care and the Lightning Process in children with chronic fatigue syndrome: feasibility randomized controlled trial (SMILE study).

Crawley, Esther, Mills, Nicola, Beasant, Lucy et al.·Trials·2013

This study tested whether it was possible to run a fair comparison trial between standard medical care and a treatment called the Lightning Process for children with ME/CFS. Researchers recruited 56 young people aged 12-18 from a specialist clinic and found that running this type of trial was workable and acceptable to patients. The study helped identify practical changes to improve how future trials should be conducted.

E1 ReplicatedTrialPEM unclearRCT

A double-blind, placebo-controlled, randomized, clinical trial of the TLR-3 agonist rintatolimod in severe cases of chronic fatigue syndrome.

Strayer, David R, Carter, William A, Stouch, Bruce C et al.·PloS one·2012

This study tested whether a drug called rintatolimod (a molecule designed to activate immune responses) could help people with severe ME/CFS. Over 230 patients received either the drug or a placebo twice a week for 40 weeks. Patients who received rintatolimod improved their exercise tolerance by about 21%, and they also needed fewer medications to manage their symptoms.

E1 ReplicatedTrialPEM not requiredRCT

[Observation on therapeutic effect of acupuncture of Back-shu acupoints for chronic fatigue syndrome patients].

Zhang, Wei, Liu, Zhi-Shun, Xu, Hai-Rong et al.·Zhen ci yan jiu = Acupuncture research·2011

This study tested whether acupuncture at specific points on the back could help people with chronic fatigue syndrome (CFS). Researchers treated 120 patients with either real acupuncture at traditional healing points or fake acupuncture at non-therapeutic locations. Both groups showed some improvement in fatigue and quality of life, but the real acupuncture group had better results and higher satisfaction after 4 weeks and 3 months.

E1 ReplicatedTrialPEM not requiredRCT

Amisulpride vs. fluoxetine treatment of chronic fatigue syndrome: a pilot study.

Pardini, Matteo, Guida, Silvia, Primavera, Alberto et al.·European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology·2011

This study tested two medications in 40 ME/CFS patients without depression: amisulpride (a low-dose psychiatric medication) and fluoxetine (an antidepressant). After 12 weeks, patients taking amisulpride reported feeling less fatigued and had fewer body aches, while those taking fluoxetine saw little improvement. Both medications were well-tolerated, suggesting amisulpride might be worth exploring further as a treatment option.

E1 ReplicatedTrialPEM not requiredRCT

[Randomized controlled study on acupuncture treatment for chronic fatigue syndrome].

Chen, Xing-Hua, Li, Lu-Qian, Zhang, Wen et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2010

This study tested whether acupuncture could help people with chronic fatigue syndrome (CFS) feel less tired. Ninety patients were divided into two groups: one received acupuncture at specific points on the head and neck, while the other received glucose and herbal injections. Both treatments reduced fatigue, but acupuncture worked better than the injection treatment.

E1 ReplicatedTrialPEM not requiredRCT

Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial.

Stubhaug, Bjarte, Lie, Stein Atle, Ursin, Holger et al.·The British journal of psychiatry : the journal of mental science·2008

This study tested whether a structured talk therapy program (cognitive-behavioural therapy) and/or a medication called mirtazapine could help people with chronic fatigue. Seventy-two patients were divided into groups receiving either the therapy program, the medication, or a placebo (fake pill). The therapy program worked best in the first 12 weeks, but when patients combined therapy first with medication afterward, they showed the most improvement by week 24.

E1 ReplicatedTrialPEM not requiredRCT

Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial.

Knoop, Hans, van der Meer, Jos W M, Bleijenberg, Gijs·The British journal of psychiatry : the journal of mental science·2008

This study tested whether simple self-help instructions based on cognitive-behavioural therapy, combined with email support, could help people with ME/CFS. Researchers compared 85 people who received this intervention with 86 people on a waiting list. The results showed that people who received the self-instructions experienced meaningful reductions in fatigue and improved daily functioning, particularly those with less severe symptoms.

E1 ReplicatedTrialPEM not requiredRCT

The effect of acclydine in chronic fatigue syndrome: a randomized controlled trial.

The, Gerard K H, Bleijenberg, Gijs, van der Meer, Jos W M·PLoS clinical trials·2007

Researchers tested whether a food supplement called Acclydine could help people with ME/CFS by increasing levels of a growth factor called IGF1. They compared 57 ME/CFS patients to healthy controls and found no difference in IGF1 levels between the groups. After 14 weeks of treatment, Acclydine did not improve fatigue, function, or IGF1 levels any better than placebo.

E1 ReplicatedTrialPEM not requiredObservational

Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Knoop, Hans, Stulemeijer, Maja, Prins, Judith B et al.·Behaviour research and therapy·2007

This study looked at whether cognitive behavioural therapy (CBT)—a type of talk therapy that helps change thought patterns and behaviors—could reduce pain in ME/CFS patients, even though it wasn't specifically designed to treat pain. Researchers found that patients who recovered from fatigue through CBT also experienced significant reductions in pain severity and the number of body areas affected by pain.

E1 ReplicatedTrialPEM not requiredRCT

Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme.

O'Dowd, H, Gladwell, P, Rogers, C A et al.·Health technology assessment (Winchester, England)·2006

This study compared three approaches for managing ME/CFS: group cognitive behavioural therapy (CBT), education and support groups, and standard medical care. After 12 months, patients who received CBT showed improvements in mental health, fatigue levels, and walking ability compared to standard care, though improvements were modest and many patients did not fully recover.

E1 ReplicatedTrialPEM not requiredRCT

The therapeutic effects of electrical acupuncture and auricular-plaster in 32 cases of chronic fatigue syndrome.

Yuemei, Li, Hongping, Liu, Shulan, Feng et al.·Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan·2006

This study tested whether electrical acupuncture combined with auricular plaster (a small patch placed on the ear) could help people with chronic fatigue syndrome. The treatment group showed improvement in about 94% of cases, compared to 75% in the group taking a standard medicine (hydrocortisone). The results suggest this traditional Chinese medicine approach may work better than the medication tested.

E1 ReplicatedTrialPEM not requiredRCT

Effect of ondansetron, a 5-HT3 receptor antagonist, on fatigue in chronic hepatitis C: a randomised, double blind, placebo controlled study.

Piche, T, Vanbiervliet, G, Cherikh, F et al.·Gut·2005

This study tested whether a medication called ondansetron, which affects serotonin in the brain, could reduce fatigue in people with chronic hepatitis C. Thirty-six patients took either ondansetron or a placebo pill for one month and were then observed for another month. Ondansetron significantly improved fatigue scores by more than 30% within two weeks and maintained this improvement, while placebo did not.

E1 ReplicatedTrialPEM not requiredRCT

Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial.

Stulemeijer, Maja, de Jong, Lieke W A M, Fiselier, Theo J W et al.·BMJ (Clinical research ed.)·2005

This study tested whether cognitive behaviour therapy (CBT)—a type of talking therapy that helps people change unhelpful thinking patterns and gradually return to activities—could help teenagers with ME/CFS. Teenagers who received 10 sessions of CBT over five months showed greater improvements in fatigue, ability to do daily activities, and school attendance compared to those who waited for treatment. The therapy was tailored based on whether teenagers were mostly active or inactive.

E1 ReplicatedTrialPEM not requiredObservational

Predictors of outcome following treatment for chronic fatigue.

Darbishire, Lucy, Seed, Paul, Ridsdale, Leone·The British journal of psychiatry : the journal of mental science·2005

This study looked at 105 people with fatigue who received either exercise therapy or talking therapy to see which patients improved and which didn't. The researchers found that having a formal diagnosis of chronic fatigue syndrome made it much less likely that people would improve with these treatments. The effect was even stronger if patients had severe limitations in daily activities or believed their illness would have serious consequences.

E1 ReplicatedTrialPEM unclearRCT

Acupuncture and Chinese patent drugs for treatment of chronic fatigue syndrome.

Lijue, Zhao·Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan·2005

This study tested whether acupuncture and traditional Chinese herbal medicines could help people with chronic fatigue syndrome (ME/CFS). Researchers compared patients who received these treatments to a control group to see if they experienced improvements in their fatigue and symptoms.

E1 ReplicatedTrialPEM not requiredRCT

Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome.

Prins, Judith, Bleijenberg, Gijs, Rouweler, Eufride Klein et al.·The British journal of psychiatry : the journal of mental science·2005

This study looked at whether having a mental health condition (like depression or anxiety) affects how well cognitive-behavioural therapy (CBT) works for ME/CFS. Researchers interviewed 270 people with ME/CFS about their psychiatric history and tracked their recovery after CBT treatment. Surprisingly, they found that people with mental health diagnoses improved just as much as those without them, suggesting that having a psychiatric condition doesn't prevent CBT from helping with ME/CFS symptoms.

E1 ReplicatedTrialPEM not requiredRCT

Biofeedback-based psychophysiological treatment in a primary care setting: an initial feasibility study.

Ryan, Meredith, Gevirtz, Richard·Applied psychophysiology and biofeedback·2004

This study tested whether biofeedback—a technique that helps people become aware of and control their body's responses—could help patients with chronic fatigue syndrome and similar conditions in a regular doctor's office. Nineteen patients received biofeedback treatment while 30 others received usual care. Patients who completed the biofeedback treatment reported fewer and less severe symptoms, and the group also had lower medical costs after treatment.

E1 ReplicatedTrialPEM not requiredRCT

Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for chronic fatigue syndrome.

Santaella, María L, Font, Ivonne, Disdier, Orville M·Puerto Rico health sciences journal·2004

This study tested whether a supplement called NADH could help people with ME/CFS feel better compared to standard nutritional supplements and counseling. Over 24 months, 12 patients received NADH while a comparison group received conventional treatment. During the first three months, patients taking NADH showed significant improvement in their symptoms, but by later time points, both groups improved at similar rates.

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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.