Evidence browser

Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review and Component Network Meta-Analysis.

Wang, Shoujian, Ren, Jun, Fang, Sitong et al.·Brain and behavior·2026

This systematic review examined 16 randomized controlled trials to understand which specific components of cognitive behavioral therapy (CBT) might be associated with fatigue improvements in ME/CFS. Researchers found that guided self-help CBT and individual CBT were observed to correlate with reduced fatigue immediately after treatment, and that certain CBT elements—particularly goal setting, third-wave components (acceptance-based techniques), and cognitive restructuring—were associated with benefits. However, one component, psychoeducation alone, was observed alongside potentially adverse outcomes, suggesting that not all CBT elements may be equally helpful.

Gut MicrobiomeEnergy MetabolismInterventionsImmune System

Gut microbiome-immune-metabolic axis in fatigue: mechanistic insights and food science approaches.

Kim, Joonbeom, Son, Bokyung, Yoo, Woongjae et al.·Food science and biotechnology·2026

This review examined research linking gut bacteria and their products to fatigue in several conditions, including ME/CFS and long COVID. Researchers observed that people with fatigue-related conditions often show alterations in their gut microbiome—for example, reduced production of beneficial short-chain fatty acids and signs of a leaky gut barrier. The review suggests that certain foods (fiber, fermented products, prebiotics, and polyphenols) may support recovery through microbiome pathways, but notes that more controlled studies are needed before drawing firm conclusions.

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.

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.

InterventionsAutonomic Nervous SystemCognitive ImpairmentPost-Exertional Malaise

Physiotherapy management of Long-COVID: an evidence-based approach.

Reeves, Jack, Daynes, Enya, Janaudis-Ferreira, Tania et al.·Brazilian journal of physical therapy·2026

This guideline describes how physiotherapists can manage Long-COVID using evidence-based approaches. The recommendations include assessment of fatigue, post-exertional malaise, breathing problems, cognitive symptoms, and orthostatic intolerance, followed by tailored management such as pacing, energy conservation, breathing retraining, and return-to-work planning. The authors emphasise the importance of validating patient experiences and individualising care, though the evidence base for these specific approaches in Long-COVID remains under development.

BiomarkersInterventionsSleepImmune System

Therapeutic plasma exchange and immunomodulatory strategies in post-infectious syndromes: A review of immune dysregulation in PTLDS, long COVID, ME/CFS, and PANS/PANDAS.

Kaplan, Gary·Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis·2026

This review examines whether immune system abnormalities in ME/CFS, long COVID, and related post-infectious conditions might respond to immune-modifying treatments such as plasma exchange and immunoglobulin therapy. The authors report that while some patients with specific immune markers showed improvements in observational studies, two large controlled trials (RituxME in ME/CFS and a TPE trial in long COVID) did not demonstrate benefit in unselected patient groups, suggesting that better ways to identify which patients might benefit are needed.

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.

Comparative effectiveness of non-pharmacological traditional Chinese medicine therapies for chronic fatigue syndrome: a systematic review and network meta-analysis.

Zhang, Yihan, Zhou, You, Xu, Hangying et al.·Frontiers in medicine·2026

A systematic review of 29 studies examined whether traditional Chinese medicine therapies—including massage, moxibustion, and cupping—were associated with improvements in fatigue, sleep, anxiety, and depression in people with chronic fatigue syndrome. The review reported that massage and moxibustion showed associations with reduced fatigue and mood symptoms, while cupping was associated with better sleep quality, though the authors note these findings should be interpreted cautiously given limitations in the underlying studies.

InterventionsSleep

Rehabilitative efficacy of cognitive behavioral therapy-based intervention for chronic fatigue syndrome: A systematic review and meta-analysis.

Jiang, Xiaoyu, Liu, Junnan, Li, Shulun et al.·Medicine·2026

A systematic review combined data from 15 randomized controlled trials (2,270 patients) examining whether cognitive behavioral therapy (CBT) was associated with improvements in fatigue, physical function, and mood in people with chronic fatigue syndrome. On average, patients who received CBT reported improvements in fatigue severity, physical functioning, and anxiety and depression scores compared to control groups, with some benefits sustained at follow-up. However, individual studies showed inconsistencies, and it remains unclear whether CBT works equally well for all patients or how benefits compare to other treatment approaches.

InterventionsSleepPost-Exertional Malaise

The efficacy of exercise in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis.

Zhao, Liping, Gou, Bo, Zhang, Meng·Journal of psychosomatic research·2026

A systematic review of 17 randomized controlled trials (involving 1,944 patients) found that exercise was associated with reported improvements in fatigue, sleep quality, quality of life, depression, and anxiety in ME/CFS patients. However, exercise did not show significant benefits for heart and lung function or overall physical capacity. The review noted no major differences in safety or tolerability between exercise and control groups, though individual responses vary and respecting personal energy limits is emphasized.

E0 ConsensusReviewPEM not requiredSystematic-Review

Effect of photobiomodulation on pain and quality of life in fibromyalgia syndrome: a systematic review.

G A, Swathi, Maiya, G Arun, Shetty, Shiran et al.·Lasers in medical science·2026

A systematic review of seven randomised controlled trials examined whether photobiomodulation therapy (a light-based treatment) could reduce pain and improve quality of life in fibromyalgia syndrome. The review reported short-term reductions in pain intensity and improvements in quality of life, sleep quality, and psychological well-being in study participants. However, the studies included were quite different from one another, which limits how widely these findings can be generalised; the authors note that larger, more standardised clinical trials are needed to clarify the actual role of this treatment.

Pain and SensitizationInterventionsSleep

Energy MetabolismInterventions

Recent Perspectives on the Physiological and Therapeutic Benefits of Placental Extracts in Chronic Noninfectious Diseases and Aging.

Xinliang, Zhang, Dudnik, Elena N, Gavrikov, Leonid K et al.·Current medicinal chemistry·2026

This systematic review examined studies on placental extracts—cell-free preparations derived from human or animal placenta—as potential treatments for various chronic diseases including metabolic disorders and liver disease. The review reports that these extracts were associated with improvements in liver function, muscle preservation, and metabolic markers in the studies reviewed; one study also mentioned chronic fatigue syndrome among the conditions examined. However, the authors note that large-scale, rigorously designed trials are needed to confirm whether these treatments actually work, and the quality of evidence underlying these associations remains unclear.

Nutraceutical Supplementation Effects on Subjective Fatigue Symptoms in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review.

Brito, Emanuella M, Bonifanti, Leonardo, Patel, Rajvi et al.·Cureus·2025

This review looked at studies testing whether vitamins, minerals, and dietary changes help ME/CFS patients feel less exhausted. Researchers found that a few supplements—like NADH, CoQ10, wasabi, and probiotics—showed promise in improving symptoms. However, many studies didn't use standardized ways to measure improvement, making it hard to compare results fairly across different research.

E0 ConsensusReviewPEM not requiredSystematic-Review

Efficacy and safety of Xiaoyao San in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis.

Wang, Qianqian, Zhou, Jian, Gong, Guanwen·Frontiers in pharmacology·2025

This review looked at whether Xiaoyao San, a traditional Chinese herbal treatment, helps people with chronic fatigue syndrome (ME/CFS). Researchers examined 6 studies with 623 patients and found that Xiaoyao San improved fatigue, reduced anxiety and depression, and caused fewer side effects compared to standard treatments. However, the overall quality of evidence was low, so we need larger, better-designed studies to be confident about these results.

Dietary Supplementation for Fatigue Symptoms in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)-A Systematic Review.

Dorczok, Marie Celine, Mittmann, Gloria, Mossaheb, Nilufar et al.·Nutrients·2025

This review looked at 14 studies examining whether dietary supplements can help reduce fatigue in ME/CFS patients. Some supplements like L-carnitine, CoQ10 combined with selenium, and NADH showed promise in reducing fatigue symptoms. However, the studies had significant quality issues, making it difficult to draw firm conclusions about which supplements truly work.

E0 ConsensusReviewPEM unclearMeta-Analysis

Effectiveness and safety of exercise therapy in patients with myalgic encephalomyelitis/chronic fatigue syndrome: a meta-analysis.

Wei, Zhenya, Wu, Heying, Cui, Chong et al.·Frontiers in neurology·2025

Researchers reviewed 13 studies involving 1,305 ME/CFS patients to see how exercise therapy affects fatigue. Exercise therapy did reduce fatigue overall, but the type of exercise mattered: traditional aerobic exercise was better for reducing overall tiredness, while a gentler practice called Qigong was better for mental fatigue. However, the researchers noted that more research is needed to fully understand whether these treatments are safe for ME/CFS patients.

E0 ConsensusReviewPEM unclearMeta-Analysis

The relation between cognitive-behavioural responses to symptoms in patients with long term medical conditions and the outcome of cognitive behavioural therapy for fatigue - A secondary analysis of four RCTs.

de Gier, M, Picariello, F, Slot, M et al.·Behaviour research and therapy·2023

This study looked at how people with different long-term illnesses—including ME/CFS—think and behave in response to fatigue, and whether these patterns affect how well cognitive behavioural therapy (CBT) works. Researchers found that certain thought patterns and behaviours, like avoiding activity or believing that fatigue causes damage, were linked to less improvement with CBT. The good news is that when CBT helped patients change these patterns—by reducing fear, worry, and excessive rest—their fatigue improved significantly.

E0 ConsensusReviewPEM not requiredSystematic-Review

[Current status of animal experiment report of acupuncture intervention in chronic fatigue syndrome based on ARRIVE guidelines and GSPC list].

Cui, Jia-He, Hu, Bin, Wang, Xin-Cao et al.·Zhen ci yan jiu = Acupuncture research·2023

This study looked at 16 animal research papers that tested whether acupuncture could help with chronic fatigue syndrome (ME/CFS). The researchers found that most of these studies had significant problems in how they reported their work—important details were missing or poorly described, making it hard to know if the results were trustworthy. The study recommends that future animal experiments follow better reporting standards to improve the quality and reliability of the research.

E0 ConsensusReviewPEM not requiredSystematic-Review

A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome.

Ingman, Tom, Smakowski, Abigail, Goldsmith, Kimberley et al.·Psychological medicine·2022

This review examined 15 studies testing whether cognitive behavioral therapy (CBT) and graded exercise therapy (GET) help adults with ME/CFS. About 44% of people felt better after CBT and 43% felt better after GET in the short to medium term, compared to smaller improvements in control groups. However, most studies were only moderate to weak quality, and results may not apply to people with severe ME/CFS.

E0 ConsensusReviewPEM not requiredMeta-Analysis

Cognitive and emotional variables predicting treatment outcome of cognitive behavior therapies for patients with medically unexplained symptoms: A meta-analysis.

Sarter, Lena, Heider, Jens, Kirchner, Lukas et al.·Journal of psychosomatic research·2021

This study looked at 37 research papers about cognitive behavior therapy (CBT)—a type of talk therapy—for people with medically unexplained symptoms. The researchers found that people who worry a lot about their symptoms, have anxiety or mood problems, tend to notice body sensations intensely, or don't believe they can manage their illness tend to get less benefit from CBT. The findings suggest that tailoring CBT to each person's specific concerns might help treatments work better.