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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.

© 2026 ME/CFS Atlas

ME/CFS Evidence Browser — Classified Studies on Myalgic Encephalomyelitis

Evidence browser

Search and filter 6,113 studies by evidence level, diagnostic criteria, PEM status, and research domain. Each entry links to the original source.

Studies sorted by review quality. 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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238 studies

E0 — Consensus629E1 — Replicated320E2 — Moderate2,745E3 — Preliminary2,419

ME/CFS4,003Long COVID206Post-infectious189Overlapping1,031

Required for diagnosis410Not specified / unclear2,176Not required3,527

Post-Exertional Malaise1,039Cognitive Dysfunction1,709Pain1,606Unrefreshing Sleep785Orthostatic Intolerance468

Cytokines812Gene Expression566Metabolomics468Neuroimaging463Autoantibodies454

Infection-Triggered1,155Long COVID Overlap562Pediatric491Severe226

Strong Phenotyping427Sex-Stratified325Severe ME Included114

Systematic Review258Meta-Analysis59RCT300

Higher42Moderate2,570Preliminary3,224Weak277

Peer-reviewed6,056Preprint3Unclear54

1–20 of 238 studies

Sorted by review status and evidence level

E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Effectiveness of Pain Neuroscience Education in Patients with Chronic Musculoskeletal Pain and Central Sensitization: A Systematic Review.

Lepri, Beatrice, Romani, Daniele, Storari, Lorenzo et al.·International journal of environmental research and public health·2023

This review looked at 15 studies testing whether pain neuroscience education—teaching patients how pain works in the nervous system—helps people with chronic muscle and joint pain, including those with conditions like fibromyalgia and chronic fatigue syndrome. The research found that this type of education does appear to reduce pain and improve disability and mood, especially when delivered one-on-one and combined with other treatments like physical therapy.

Pain and Sensitization

E0 ConsensusPEM unclearWeak / uncertainSystematic-ReviewEditor reviewed

Interventions to treat pain in paediatric CFS/ME: a systematic review.

Ascough, Caitlin, King, Hayley, Serafimova, Teona et al.·BMJ paediatrics open·2020

This review looked at whether treatments for ME/CFS in children help reduce pain, which affects about two-thirds of young patients. Researchers searched medical databases for studies measuring pain before and after treatment. They found that most treatment studies didn't even measure pain, and the few that did weren't specifically designed to treat pain—they focused on overall ME/CFS management. The evidence suggests that children who recover from ME/CFS tend to have less pain than those who don't recover.

Pain and Sensitization

E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

A systematic review on the health outcomes associated with non-endocarditis manifestations of chronic Q fever.

Manchal, Naveen, Adegboye, Oyelola A, Eisen, Damon P·European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology·2020

This study looked at chronic Q fever, a bacterial infection that can cause long-term complications beyond heart valve infections. Researchers found that when chronic Q fever affects bones, blood vessels, or causes abscesses (pockets of infection), patients experience significantly more pain than other forms of the disease. Importantly, the study reviewed existing research to understand how pain and fatigue appear in these less common forms of chronic Q fever.

Pain and Sensitization

E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review.

Carreira, Helena, Williams, Rachael, Strongman, Helen et al.·BMJ open·2019

Researchers reviewed 120 studies that used UK patient medical records to track mental health and quality of life problems like depression, anxiety, fatigue, and cognitive issues. They found that different studies used different definitions and coding systems to identify these conditions, making it hard to compare results across studies. The authors recommend that researchers agree on standard definitions and validated code lists so findings are more consistent and reliable.

Pain and SensitizationSleepCognitive Impairment

E0 ConsensusPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Pathophysiology of interstitial cystitis.

Birder, Lori A·International journal of urology : official journal of the Japanese Urological Association·2019

Interstitial cystitis is a chronic bladder pain condition with no clear cause and no universally accepted treatment. This review examines how bladder pain occurs without obvious damage to bladder tissue or nerves, and notes that patients with this condition often have overlapping symptoms with other chronic pain syndromes like fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. Researchers use animal models and look for biomarkers in urine to better understand the condition and develop new treatments.

Pain and Sensitization

E0 ConsensusPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Are Traditional Remedies Useful in Management of Fibromyalgia and Chronic Fatigue Syndrome? A Review Study.

Mahjoub, Fatemeh, Salari, Roshanak, Noras, Mohammad Reza et al.·Journal of evidence-based complementary & alternative medicine·2017

This study looked at how traditional Persian medicine approaches fibromyalgia and ME/CFS, which are conditions that cause widespread pain and extreme tiredness. The researchers compared ancient Persian medical texts, particularly writings by the physician Avicenna, with modern understanding of these diseases. They found that traditional medicine recognized fatigue as a complex condition with different types, each with distinct symptoms.

Pain and Sensitization

E0 ConsensusPEM not requiredModerate confidenceGuidelineEditor reviewed

Chronic Pelvic Pain in Women.

Speer, Linda M, Mushkbar, Saudia, Erbele, Tara·American family physician·2016

Chronic pelvic pain in women is long-lasting pain in the pelvic area that lasts more than six months and often has no clear cause. This guideline explains that pelvic pain is frequently linked to other pain conditions and mental health issues like depression, and recommends a whole-person approach to treatment that combines medical care, physical therapy, and behavioral support.

Pain and Sensitization

E0 ConsensusPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Yoga intervention and functional pain syndromes: a selective review.

Sutar, Roshan, Yadav, Suresh, Desai, Geetha·International review of psychiatry (Abingdon, England)·2016

This review looked at studies examining whether yoga might help people with chronic pain conditions that are hard to diagnose, including ME/CFS. The researchers found that several studies suggested yoga may provide modest benefits for these types of pain conditions. However, more large-scale research is needed to confirm how helpful yoga really is.

Pain and Sensitization

E0 ConsensusPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Neuroimaging of Central Sensitivity Syndromes: Key Insights from the Scientific Literature.

Walitt, Brian, Ceko, Marta, Gracely, John L et al.·Current rheumatology reviews·2016

This review examined brain imaging studies of ME/CFS and similar conditions to understand what happens in the nervous system. Researchers found that people with these conditions show increased sensitivity to pain and other sensations, suggesting these are real physical conditions—not imaginary or feigned. However, brain imaging hasn't yet revealed a single clear pattern or 'fingerprint' that all these conditions share, and we still don't know if this sensory sensitivity causes the disease or is a result of it.

Pain and Sensitization

E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

Bladder pain syndrome/interstitial cystitis as a functional somatic syndrome.

Warren, John W·Journal of psychosomatic research·2014

This study asks whether bladder pain syndrome/interstitial cystitis (BPS/IC) is a type of functional somatic syndrome—a condition where symptoms are real but may not show up on standard tests. The researchers reviewed existing research and found that BPS/IC shares most characteristics with other functional somatic syndromes, suggesting that at least some cases of BPS/IC might work similarly to conditions like ME/CFS.

Pain and Sensitization

E0 ConsensusPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

Gynecological disorders in bladder pain syndrome/interstitial cystitis patients.

Cervigni, Mauro, Natale, Franca·International journal of urology : official journal of the Japanese Urological Association·2014

This review examined how often bladder pain syndrome (chronic bladder inflammation and pain) occurs together with gynecological conditions like endometriosis and vulvodynia in women. The researchers found that these conditions frequently overlap—for example, about 48% of women with endometriosis also have bladder pain syndrome. They also found that pelvic floor muscle dysfunction is very common in bladder pain patients, affecting up to 87% of them.

Pain and Sensitization

E0 ConsensusPEM unclearModerate confidenceReview-NarrativeEditor reviewed

Dysfunctional syndromes and fibromyalgia: a 2012 critical digest.

Sarzi-Puttini, Piercarlo, Atzeni, Fabiola, Di Franco, Manuela et al.·Clinical and experimental rheumatology·2012

This review looked at several long-lasting conditions that cause widespread pain, tiredness, sleep problems, and difficulty concentrating—conditions that don't always show up clearly on standard medical tests. The researchers examined fibromyalgia, ME/CFS, and irritable bowel syndrome to understand how they're connected and what causes symptoms to keep happening. They found that these conditions share similar patterns in how the nervous system processes pain and fatigue.

Pain and SensitizationCognitive Impairment

E0 ConsensusPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

The prevalence of fibromyalgia in other chronic pain conditions.

Yunus, Muhammad B·Pain research and treatment·2012

This review examined how often fibromyalgia (a condition causing widespread pain and fatigue) occurs alongside other chronic pain conditions, including ME/CFS. The researchers found that fibromyalgia frequently co-occurs with conditions like rheumatoid arthritis, lupus, and osteoarthritis, and that it can be missed or misdiagnosed in people who have these other diseases. Recognizing fibromyalgia separately is important because it may change how doctors treat patients and what medications they use.

Pain and Sensitization

E0 ConsensusPEM unclearModerate confidenceSystematic-ReviewEditor reviewed

Systematic review of multi-symptom conditions in Gulf War veterans.

Thomas, Hollie V, Stimpson, Nicola J, Weightman, Alison L et al.·Psychological medicine·2006

This review examined 23 studies comparing health problems in Gulf War veterans to people who were not deployed. Veterans who served in the Gulf War were nearly 4 times more likely to develop chronic fatigue syndrome and about 3.5 times more likely to report multiple chemical sensitivities or other multi-symptom illnesses. The review suggests that deployment to the Gulf War is connected with higher rates of these conditions.

Pain and Sensitization

E0 ConsensusPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Genetic factors in neuromuscular pain.

Buskila, Dan, Neumann, Lily, Press, Joseph·CNS spectrums·2005

This review examined whether ME/CFS, fibromyalgia, and related chronic pain conditions share genetic roots. Researchers looked at recent studies suggesting that genes involved in serotonin and dopamine—brain chemicals that affect mood and pain—may make some people more likely to develop these conditions. The review also highlights that environmental triggers (like infections or stress) likely play a role in people who are genetically predisposed.

Pain and Sensitization

E0 ConsensusPEM not requiredModerate confidenceMeta-AnalysisEditor reviewed

Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms.

Cairns, Victoria, Godwin, Jon·International journal of epidemiology·2005

This study looked at patients who had Lyme disease and found that many experienced long-lasting fatigue, muscle and joint pain, and thinking difficulties even after antibiotic treatment. Researchers combined results from five previous studies comparing Lyme disease patients to healthy controls and found these symptoms were significantly more common in the Lyme disease group. The symptom pattern was notably different from other conditions like fibromyalgia or depression.

Pain and SensitizationCognitive Impairment

E0 ConsensusPEM unclearPreliminaryReview-NarrativeEditor reviewed

Fibromyalgia syndrome, idiopathic widespread persistent pain or syndrome of myalgic encephalomyelopathy (SME): what is its nature?

Mehendale, Anand W, Goldman, Mark P·Pain practice : the official journal of World Institute of Pain·2002

This review summarizes what scientists and doctors know about fibromyalgia and ME/CFS by examining research from the past 25 years. The authors looked at studies on symptoms, causes, blood test findings, brain imaging, and what patients reported about their experiences. They propose that these conditions may need to be understood in an entirely new way.

Pain and Sensitization

E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

[What happens to the fibromyalgia syndrome?].

Maquet, D, Croisier, J L, Crielaard, J M·Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique·2001

This review examined fibromyalgia, a condition causing widespread muscle and joint pain that lasts at least three months. The researchers found that fibromyalgia involves multiple problems working together: abnormal pain processing in the nervous system, poor sleep quality, muscle weakness, and hormonal imbalances. They concluded that treating fibromyalgia effectively requires a team approach addressing all these different issues, not just pain alone.

Pain and Sensitization

E1 ReplicatedPEM not requiredModerate confidenceCross-SectionalEditor reviewed

Prevalence of Chronic Overlapping Pain Conditions in Participants With Chronic Low Back Pain Enrolled in a Pragmatic Trial of Mindfulness-Based Stress Reduction.

Miller, Vanessa Eve, Barnhill, Jessica, Greco, Carol M et al.·European journal of pain (London, England)·2025

This study looked at people with chronic low back pain to see how often they also have other long-term pain conditions like fibromyalgia, irritable bowel syndrome, and ME/CFS. Researchers found that 45% of people with back pain also had at least one other chronic pain condition, and these people reported more pain, fatigue, anxiety, and depression than those with back pain alone. The study suggests that chronic pain conditions often occur together and may share similar underlying causes.

Pain and Sensitization

E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial.

Rivas Neira, S, Pasqual Marques, A, Fernández Cervantes, R et al.·Physiotherapy·2024

This study compared two types of exercise therapy for women with fibromyalgia: exercising in a pool (aquatic therapy) versus exercising on land. Both groups did 60-minute exercise sessions three times a week for 12 weeks. Six weeks after the program ended, women who did aquatic therapy reported less pain and better sleep quality than those who exercised on land, suggesting that water-based exercise may be particularly helpful for fibromyalgia.

Pain and SensitizationSleep

Next 20 studies →

Or browse by topic

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.