Evidence browser

BiomarkersDiagnosticsLong COVID Overlap

Dynamic microclot profiling: thromboelastography advances precision management in long COVID and myalgic encephalomyelitis/chronic fatigue syndrome.

Saleem, Shafaq, Hussain, Ahmad, Haroon, Muhammad et al.·Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis·2026

This review examined whether a blood test called thromboelastography (TEG) could help diagnose and manage long COVID and ME/CFS by detecting microclots—tiny blood clots thought to persist in these conditions. Studies included in the review reported that microclots are commonly observed in both conditions, and that TEG shows patterns suggestive of altered blood clotting in long COVID patients. However, the review notes that TEG is not yet standardized across laboratories, and treatments targeting microclots (such as certain anticoagulants) still require further testing.

InterventionsDiagnosticsCognitive Impairment

Digital Approaches for Managing Brain Fog in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Interventions, Monitoring, and Future Directions.

Araja, Diana, Murovska, Modra, Krumina, Angelika et al.·Life (Basel, Switzerland)·2026

This review examined how digital tools—such as apps and online platforms—might help people with ME/CFS monitor and manage 'brain fog', a common cognitive difficulty patients report. The authors found that while some digital assessment tools show promise, most approaches for using technology to help with brain fog remain under-studied and limited in evidence. Digital monitoring and rehabilitation approaches are less well-established than cognitive assessment tools.

NeuroinflammationPain and SensitizationInterventionsSleep

Multimorbidity in Chronic Overlapping Pain Conditions: From Burden to Integrated Care.

d'Incau, Emmanuel, Kaplan, Chelsea Marie, Micoulaud-Franchi, Jean-Arthur et al.·Journal of clinical medicine·2026

This evidence map examines chronic overlapping pain conditions—a group of ten disorders including fibromyalgia, migraine, irritable bowel syndrome, and ME/CFS that frequently occur together in the same patients. Researchers observed that when multiple conditions coexist, patients report greater pain, worse sleep, more fatigue, and lower quality of life, along with fragmented care across many specialists. The review proposes that integrated screening and coordinated care might help, though effectiveness of these approaches remains to be tested.

Use of artificial intelligence and machine learning for the management of fibromyalgia: a scoping review.

Clempi Almeida E Silva, Ana Laura, Reis, Victor Hugo Palhares Flávio, Lamoglia, Antonieta Santos Andrade et al.·The Journal of manual & manipulative therapy·2026

This review looked at 43 studies from 2011–2024 to see how artificial intelligence (AI) and machine learning can help diagnose fibromyalgia and other conditions like ME/CFS. Researchers found that AI tools can identify unique patterns in brain scans, genes, eye imaging, and blood markers that differ between sick patients and healthy people. While some AI models showed very high accuracy (up to 100%), most studies tested only small groups of patients, so we need bigger, more rigorous research before these tools can be used reliably in clinics.

InterventionsAutonomic Nervous SystemDiagnosticsLong COVID Overlap

[Post-COVID: An inventory focusing on the key complaints PEM and POTS].

Hensel, Ole, Pfrommer, Laura, Furch, Peggy et al.·MMW Fortschritte der Medizin·2026

This is a narrative review (a summary of existing research rather than a new study) that examined long-term effects of COVID-19, with a focus on post-exertional malaise (PEM) and postural tachycardia syndrome (POTS). The authors report that in people with post-COVID, PEM—a worsening of symptoms after exertion—was observed in approximately 86% of patients, and POTS-related symptoms in up to 82%. The review suggests pacing and symptom-focused treatments may help, though these are early findings from a narrative synthesis rather than definitive evidence.

E0 ConsensusGuidelinePEM unclearGuideline

[Interdisciplinary consensus statement about the diagnosis and treatment of chronic fatigue syndrome/myalgic encephalomyelopathy].

Simonyi, Gábor, Bedros, J Róbert, Réthelyi, János et al.·Orvosi hetilap·2025

This paper is a consensus statement from multiple medical experts that reviews what is currently known about ME/CFS, including its varied symptoms affecting the body, thinking, mood, and daily functioning. The authors recognize that ME/CFS is increasingly common but still not well understood or acknowledged in Hungarian medicine, so they compiled international guidelines and treatment suggestions to help healthcare providers better care for patients with this condition.

Ignored, dismissed, and minimized: Understanding the harmful consequences of invalidation in health care-A systematic meta-synthesis of qualitative research.

Bontempo, Allyson C, Bontempo, John M, Duberstein, Paul R·Psychological bulletin·2025

This study looked at how doctors dismissing or minimizing patients' symptoms affects people with hard-to-diagnose illnesses like ME/CFS. Researchers reviewed over 150 studies involving more than 11,000 patients and found that when doctors don't believe or validate patients' experiences, it causes serious harm—including shame, anxiety about healthcare, avoidance of doctors, and delays in getting diagnosed. The study shows that invalidation by healthcare providers can actually make patients' health outcomes worse.

E0 ConsensusReviewPEM not requiredReview-Narrative

Autoimmune Autonomic Neuropathy: From Pathogenesis to Diagnosis.

Nakane, Shunya, Koike, Haruki, Hayashi, Tomohiro et al.·International journal of molecular sciences·2024

This review describes autoimmune autonomic ganglionopathy (AAG), a rare condition where the immune system attacks nerve cells that control automatic body functions like heart rate and blood pressure. The authors explain how doctors can diagnose AAG and how it differs from other similar conditions, including ME/CFS and long COVID, which can have overlapping symptoms.

Autonomic Nervous SystemDiagnostics

E0 ConsensusReviewPEM unclear

Myalgic encephalomyelitis/chronic fatigue syndrome from current evidence to new diagnostic perspectives through skeletal muscle and metabolic disturbances.

Pietrangelo, Tiziana, Cagnin, Stefano, Bondi, Danilo et al.·Acta physiologica (Oxford, England)·2024

This review examines what we know about ME/CFS by focusing on problems in muscles and how the body uses energy. Researchers looked at existing research to understand why ME/CFS causes severe tiredness and muscle problems. The authors suggest that studying muscle tissue more closely might help doctors diagnose ME/CFS better and develop new treatments.

E0 ConsensusReviewPEM not requiredGuideline

Celiac Disease-Related Conditions: Who to Test?

Zingone, Fabiana, Bai, Julio C, Cellier, Christophe et al.·Gastroenterology·2024

This review looked at which patients should be tested for celiac disease, a condition where the immune system reacts to gluten in food. The authors found that celiac disease is often missed and recommend testing in people with certain autoimmune diseases, digestive problems, thyroid disease, and other specific conditions—including chronic fatigue syndrome. They suggest blood tests first, with biopsies during endoscopy if needed to confirm the diagnosis.

E0 ConsensusGuidelinePEM unclear

NICE guideline on ME/CFS: robust advice based on a thorough review of the evidence.

Barry, Peter Walter, Kelley, Kate, Tan, Toni et al.·Journal of neurology, neurosurgery, and psychiatry·2024

In 2021, NICE (the UK's health guideline organization) published official recommendations for diagnosing and treating ME/CFS based on careful review of available research. When critics raised concerns about how the evidence was interpreted, the guideline authors explained that these criticisms were based on misunderstandings of how the guideline process works. This paper defends the guideline as a balanced and thoughtful approach to managing this serious condition.

E0 ConsensusGuidelinePEM requiredGuideline

Appraisal of Clinical Practice Guideline: National Institute for Health and Care Excellence (NICE) clinical practice guideline for myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management.

F Tyson, Sarah·Journal of physiotherapy·2024

This paper reviews the 2021 NICE guidelines, which are official recommendations from the UK's National Institute for Health and Care Excellence on how to diagnose and treat ME/CFS. The review examines whether these guidelines are well-supported by evidence and practical for patients and healthcare providers to use. This is important because good clinical guidelines help ensure patients receive consistent, evidence-based care.

E0 ConsensusReviewPEM unclearEvidence-Map

Healthcare system barriers impacting the care of Canadians with myalgic encephalomyelitis: A scoping review.

Hussein, Said, Eiriksson, Lauren, MacQuarrie, Maureen et al.·Journal of evaluation in clinical practice·2024

This study looked at all available Canadian research to understand why people with ME/CFS struggle to get good healthcare. The researchers found that the main problems are: doctors often don't believe ME is real, healthcare providers aren't trained to recognize it, there's a lack of good information about the disease, and sexism plays a role. The study suggests that improving doctor education and creating better care systems could help ME patients get the support they need.

Systematic review of fatigue severity in ME/CFS patients: insights from randomized controlled trials.

Park, Jae-Woong, Park, Byung-Jin, Lee, Jin-Seok et al.·Journal of translational medicine·2024

This study looked at 60 previous clinical trials involving over 7,000 ME/CFS patients to understand how severe their fatigue really is. Researchers converted all the different fatigue measurements used in these trials into a common scale (0-100) so they could compare results. They found that ME/CFS patients experience very high fatigue levels (around 78 out of 100), affecting their thinking, physical abilities, and mood in different ways.

E0 ConsensusReviewPEM not requiredSystematic-Review

The role of psychiatry in diagnosis and treatment of paediatric chronic fatigue syndrome - a scoping literature review.

Dolp, Reinhard, Wardle, David Pr, Khalid-Khan, Sarosh·International journal of adolescent medicine and health·2023

This review looked at how psychiatry (the medical specialty focused on mental health) is involved in diagnosing and treating ME/CFS in children and teenagers. The researchers searched medical literature and found that psychiatrists are rarely part of the care team for young people with ME/CFS, and when they are involved, their role is often unclear or limited to treating separate mental health problems. The study suggests that psychiatry could potentially play a more defined and helpful role in caring for children and adolescents with ME/CFS.

E0 ConsensusGuidelinePEM requiredGuideline

NICE sets out steps NHS must take to implement ME/CFS guidelines.

Torjesen, Ingrid·BMJ (Clinical research ed.)·2022

In 2022, the UK's National Institute for Health and Care Excellence (NICE) released official guidelines for how the NHS should diagnose and treat ME/CFS. This article describes the key steps the NHS was told to take to implement these new guidelines. The guidelines aim to improve care and support for people living with ME/CFS across the country.

E0 ConsensusGuidelinePEM unclearGuideline

Approach to Fatigue: Best Practice.

Dukes, Jason C, Chakan, Matthew, Mills, Aaron et al.·The Medical clinics of North America·2021

Fatigue can come from many different causes, so doctors need to carefully listen to patients' histories and perform physical exams rather than just ordering lots of tests. Fatigue may be caused by an underlying medical condition that can be treated, or it may be a primary condition on its own (now called system exertion intolerance disease). Currently, there are no FDA-approved medications specifically for primary fatigue, so treatment focuses on personalized exercise programs and cognitive behavioral therapy.

E0 ConsensusGuidelinePEM requiredGuideline

Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management

NICE Guideline Committee·National Institute for Health and Care Excellence (NICE)·2021

The UK's National Institute for Health and Care Excellence updated its ME/CFS guidelines after a comprehensive evidence review. The updated guidelines removed Graded Exercise Therapy (GET) and Cognitive Behavioural Therapy (CBT) as recommended treatments, as evidence showed they were not effective and could be harmful. Pacing and energy management were endorsed.

InterventionsDiagnostics

Recovery from chronic fatigue syndrome: a systematic review-heterogeneity of definition limits study comparison.

Moore, Yasmin, Serafimova, Teona, Anderson, Nina et al.·Archives of disease in childhood·2021

This study looked at how often children with ME/CFS recover and what 'recovery' actually means. Researchers found that different studies define recovery in very different ways—some focus on returning to school, others on fatigue levels, and others on physical activity. Because of these differences, recovery rates ranged wildly from 4.5% to 83%, making it hard to compare studies fairly.

A Literature Review of GP Knowledge and Understanding of ME/CFS: A Report from the Socioeconomic Working Group of the European Network on ME/CFS (EUROMENE).

Pheby, Derek F H, Araja, Diana, Berkis, Uldis et al.·Medicina (Kaunas, Lithuania)·2020

This study looked at what general practitioners (GPs) know and believe about ME/CFS by reviewing 33 research papers. The researchers found that many GPs don't believe ME/CFS is a real illness or don't feel confident diagnosing it, and patients often report feeling dismissed by their doctors. This problem has been going on for decades and hasn't improved much.