Evidence browser

Effect of Dietary Coenzyme Q10 Plus NADH Supplementation on Fatigue Perception and Health-Related Quality of Life in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

Castro-Marrero, Jesús, Segundo, Maria Jose, Lacasa, Marcos et al.·Nutrients·2021

This study tested whether taking two supplements together—coenzyme Q10 and NADH—could help reduce fatigue and improve quality of life in people with ME/CFS. Over 200 patients took either the supplements or a placebo for 12 weeks. The group taking the supplements reported feeling less mentally tired, slept better, and experienced improvements in their overall quality of life compared to the placebo group.

Effect of Melatonin Plus Zinc Supplementation on Fatigue Perception in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.

Castro-Marrero, Jesús, Zaragozá, Maria-Cleofé, López-Vílchez, Irene et al.·Antioxidants (Basel, Switzerland)·2021

This study tested whether taking melatonin (1 mg) and zinc (10 mg) together could help reduce fatigue in ME/CFS patients. Over 16 weeks, people taking the supplement reported feeling less physically tired compared to those taking placebo, and they also reported better overall quality of life. The supplements appeared to be safe with no serious side effects reported.

[Ginger-separated moxibustion for chronic fatigue syndrome and its effect on intestinal flora].

Lin, Yu-Fang, Jin, Xiao-Qing, Zhu, Jian-Fang et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2021

This study tested whether ginger-separated moxibustion (a traditional Chinese medicine technique involving heat applied to the skin over specific points) could help reduce fatigue in ME/CFS patients. Over 4 weeks, patients receiving moxibustion treatment along with normal diet and exercise showed significantly greater improvements in fatigue symptoms compared to those receiving diet and exercise alone. The treatment also appeared to change the types of bacteria in patients' guts in ways that might support better intestinal health.

Gut Microbiome

A Botanical Product Containing Cistanche and Ginkgo Extracts Potentially Improves Chronic Fatigue Syndrome Symptoms in Adults: A Randomized, Double-Blind, and Placebo-Controlled Study.

Kan, Juntao, Cheng, Junrui, Hu, Chun et al.·Frontiers in nutrition·2021

Researchers tested whether a supplement containing two plant extracts (cistanche and ginkgo) could help adults with ME/CFS. Over 60 days, people taking the supplement reported improvements in fatigue, memory, sleep quality, and ability to exercise compared to those taking a placebo. The treatment also lowered certain chemicals in the blood (ammonia and lactic acid) that may be linked to fatigue.

Post-Exertional Malaise

Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial.

Clark, Lucy V, McCrone, Paul, Pesola, Francesca et al.·Journal of psychosomatic research·2021

This study followed up with CFS patients one year after they received either guided graded exercise self-help (a structured program to gradually increase activity) or standard medical care. While the exercise program showed better results after 12 weeks, by 15 months both groups had improved similarly, with the exercise group maintaining their gains and the standard care group catching up. The exercise program cost slightly more but was considered cost-effective based on quality of life improvements.

Effectiveness a herbal medicine (Sipjeondaebo-tang) on adults with chronic fatigue syndrome: A randomized, double-blind, placebo-controlled trial.

Shin, Seungwon, Park, Soo Jung, Hwang, Minwoo·Integrative medicine research·2021

This study tested whether a traditional Korean herbal medicine called Sipjeondaebo-tang could help people with ME/CFS feel less tired. Ninety-six patients took either the herbal medicine or a placebo (fake medicine) for 8 weeks. While the herbal medicine did not meet the study's main success measure, it did help reduce fatigue severity on several fatigue rating scales and was safe to use.

Recruiting Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis to Internet-Delivered Therapy: Internal Pilot Within a Randomized Controlled Trial.

Anderson, Emma, Parslow, Roxanne, Hollingworth, William et al.·Journal of medical Internet research·2020

This study tested whether teenagers with ME/CFS could successfully receive specialist treatment through the internet instead of traveling to hospitals. Researchers recruited 89 young people across the UK and offered them two types of online treatment: a cognitive behavioral therapy program with messaging support from a psychologist, or activity management sessions over Skype with a physiotherapist. Most participants completed the study and found the online treatment acceptable, showing that remote delivery of ME/CFS care is workable.

The Effect of Parenteral or Oral Iron Supplementation on Fatigue, Sleep, Quality of Life and Restless Legs Syndrome in Iron-Deficient Blood Donors: A Secondary Analysis of the IronWoMan RCT.

Macher, Susanne, Herster, Cornelia, Holter, Magdalena et al.·Nutrients·2020

This study looked at whether giving iron supplements to blood donors with iron deficiency could improve fatigue, sleep problems, and restless legs syndrome. After 8-12 weeks of taking either intravenous or oral iron supplements, patients reported significant improvements in fatigue, sleep quality, and restless legs symptoms, along with fewer headaches and dizziness. Both types of iron supplementation worked similarly well.

The feasibility and acceptability of an early intervention in primary care to prevent chronic fatigue syndrome (CFS) in adults: randomised controlled trial.

O'Dowd, Hazel, Beasant, Lucy, Ingram, Jenny et al.·Pilot and feasibility studies·2020

Researchers wanted to test whether early treatment could prevent long-term fatigue (ME/CFS) from developing in people who had recently become ill. They offered some patients psychological support and cognitive behavioural therapy alongside their regular care. However, the study found that doctors struggled to identify patients early enough, and some patients didn't find the treatment approach helpful for their situation.

E1 ReplicatedTrialPEM requiredRCT

[Scraping on head and face combined with stepping technique of tuina along lower limbs for chronic fatigue syndrome].

Lei, Long-Ming, Wu, Qiong-Yuan, He, Yu-Feng·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2020

This study tested whether a traditional Chinese medicine approach combining facial scraping and leg massage techniques could help ME/CFS patients feel less tired and mentally better. Patients receiving these techniques plus standard vitamin treatment showed greater improvement in fatigue and mood scores compared to those receiving vitamins alone.

Cognitive-behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study.

Malik, Sadaf, Asprusten, Tarjei Tørre, Pedersen, Maria et al.·BMJ paediatrics open·2020

This study tested whether combining two types of therapy—cognitive-behavioral therapy (which helps change thought patterns and behaviors) and music therapy—could help adolescents recover from prolonged fatigue that started after an Epstein-Barr virus infection. Over 15 months, researchers compared 21 young people who received the combined therapy with 22 who received standard care. The therapy was safe and well-tolerated, and there were hints that it might help with symptom recovery, though the study was too small to prove effectiveness.

Post-Exertional Malaise

E1 ReplicatedCohortPEM requiredObservational

Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia

C. M. C. van Campen, F. C. Visser, P. C. Rowe·Journal of Internal Medicine·2020·n=429

In the largest study of its kind, 429 ME/CFS patients underwent head-up tilt testing with simultaneous cerebral blood flow monitoring. Nearly all ME/CFS patients showed significantly reduced cerebral blood flow when upright, even when blood pressure and heart rate were normal. The reduction correlated with symptom severity.

Autonomic Nervous SystemCognitive Impairment

Effect of disease duration in a randomized Phase III trial of rintatolimod, an immune modulator for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Strayer, David R, Young, Diane, Mitchell, William M·PloS one·2020

This study tested a drug called rintatolimod in ME/CFS patients to see if it could improve their ability to exercise. The researchers found that patients who had been sick for 2-8 years responded much better to the drug than those who had been sick for less than 2 years or more than 8 years. Over half of the patients in the right disease duration window improved their exercise capacity by at least 25%, which also improved their quality of life.

The effectiveness of cupping therapy on chronic fatigue syndrome: A single-blind randomized controlled trial.

Meng, Xiu-Dong, Guo, Hao-Ran, Zhang, Qing-Ying et al.·Complementary therapies in clinical practice·2020

This study tested whether cupping therapy—a traditional treatment where cups create suction on the skin—could help people with ME/CFS feel less tired. Researchers divided 112 patients into three groups that received different levels of suction and compared the results. After 10 sessions over 5 weeks, all groups reported improvements in fatigue and sleep, with 10 sessions working better than 5 sessions, though the pressure levels didn't make much difference.

[Effect of ginger-separated moxibustion on fatigue, sleep quality and depression in patients with chronic fatigue syndrome: a randomized controlled trial].

Lin, Yu-Fang, Zhu, Jian-Fang, Chen, Yi-Dan et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2020

This study tested whether ginger-separated moxibustion (a traditional Chinese medicine technique involving burning herbs on the skin) could help ME/CFS patients feel less tired, sleep better, and feel less depressed. Over 4 weeks, patients who received moxibustion in addition to normal diet and exercise showed significant improvements in fatigue, sleep quality, and depression compared to those who only made lifestyle changes.

E1 ReplicatedTrialPEM requiredRCT

B-Lymphocyte Depletion in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.

Fluge, Øystein, Rekeland, Ingrid G, Lien, Katarina et al.·Annals of internal medicine·2019

Researchers tested whether a drug called rituximab, which reduces B cells (a type of immune cell), could help ME/CFS patients. Over 150 patients received either rituximab infusions or placebo over one year. Unexpectedly, the placebo group actually did slightly better than the treatment group, and neither group showed significant improvement in fatigue or function.

Immune System

[Acupuncture in the treatment of chronic fatigue syndrome based on "interaction of brain and kidney" in TCM: a randomized controlled trial].

Xu, Yu-Xin, Luo, Hua-Song, Sun, Dong et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2019

This study tested whether acupuncture could help people with ME/CFS feel less tired and sleep better. Sixty-eight patients were divided into two groups: one received acupuncture twice a week for four weeks along with standard care (rest and vitamins), while the other received only standard care. The acupuncture group showed greater improvements in fatigue, overall wellbeing, and sleep quality compared to the control group.

Immune System

Internet-Based Cognitive Behavioral Therapy in Stepped Care for Chronic Fatigue Syndrome: Randomized Noninferiority Trial.

Worm-Smeitink, Margreet, Janse, Anthonie, van Dam, Arno et al.·Journal of medical Internet research·2019

This study tested whether ME/CFS patients could be treated effectively with online cognitive behavioral therapy (a talk therapy done through a computer), with face-to-face therapy available if needed, compared to standard face-to-face therapy alone. The online therapy worked about as well as in-person therapy for reducing fatigue and disability, but used significantly less therapist time, making it potentially more efficient.