TreatmentPEM-relevant

Interventions

205 studies in the atlas

There is currently no approved cure or disease-modifying treatment for ME/CFS. Management focuses on symptom relief and avoiding PEM triggers. Several pharmacological and non-pharmacological interventions have been studied, with mixed or limited results. Pacing remains the most widely recommended self-management strategy.

What we know

No pharmacological treatment has been approved specifically for ME/CFS
Pacing (activity management within energy limits) is the most widely recommended self-management approach
NICE 2021 guidelines no longer recommend graded exercise therapy (GET) as traditionally practiced
Symptomatic treatments for sleep, pain, and orthostatic intolerance may help individual symptoms

What remains uncertain

Whether low-dose naltrexone benefits a subset of patients (small trials show mixed results)
Rituximab trials initially showed promise but a larger RCT did not confirm benefit
Whether IVIG benefits specific immune subgroups remains debated
Antiviral treatments have been explored but evidence is insufficient for broad recommendations

What is emerging

Whether Long COVID treatment trials will yield therapies applicable to ME/CFS
The potential of targeted immunomodulatory approaches for specific patient subgroups
Whether early intervention after infection can prevent development of ME/CFS
The role of mitochondrial support supplements (CoQ10, NAD+ precursors) — evidence is preliminary

Start here

E0 ConsensusPEM required

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.

Research Momentum

198 publications over 36 years. Recent trend: decreasing (4/year over the last 3 years).

Top Studies

60 of 205, sorted by evidence level and year

E0ReviewPEM ?

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

2026

Zhao, Liping et al.·Journal of psychosomatic research·Systematic-Review

E0ReviewPEM ?

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

2026

Zhang, Yihan et al.·Frontiers in medicine·Systematic-Review

E0ReviewPEM ?

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

2026

Araja, Diana et al.·Life (Basel, Switzerland)·Review-Narrative

Interventions

What we know

What remains uncertain

What is emerging

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

Research Momentum

Top Studies

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

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

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

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

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

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

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

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

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

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

Cost-effectiveness of Interventions for Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: A Systematic Review of Economic Evaluations.

Moxibustion for Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis.

Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review.

Patients' experiences and effects of non-pharmacological treatment for myalgic encephalomyelitis/chronic fatigue syndrome - a scoping mixed methods review.

Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

Advances in Clinical Research on Traditional Chinese Medicine Treatment of Chronic Fatigue Syndrome.

Child and adolescent chronic fatigue syndrome/myalgic encephalomyelitis: where are we now?

Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review.

Exercise therapy is a beneficial intervention for chronic fatigue syndrome (PEDro synthesis).

Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent.

Multidisciplinary rehabilitation treatment is not effective for myalgic encephalomyelitis/chronic fatigue syndrome: A review of the FatiGo trial.

Role of dietary modification in alleviating chronic fatigue syndrome symptoms: a systematic review.

Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis.

Pediatric chronic fatigue syndrome: current perspectives.

A Systematic Review of Drug Therapies for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.

Chronic fatigue syndrome.

Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials.

Is there effective behavioural treatment for children with chronic fatigue syndrome/myalgic encephalomyelitis?

Treating chronic fatigue syndrome - a study into the scientific evidence for pharmacological treatments.

[A meta analysis on randomized controlled trials of acupuncture treatment of chronic fatigue syndrome].

Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome.

Cognitive behaviour therapy for chronic fatigue syndrome in adults.

Treatment of chronic fatigue syndrome: findings, principles and strategies.

Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis.

The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis.

Chronic fatigue syndrome.

Interventions for the treatment and management of chronic fatigue syndrome: a systematic review.

Chronic fatigue syndrome.

Cognitive behaviour therapy for adults with chronic fatigue syndrome.

Cognitive behavior therapy for chronic fatigue syndrome: efficacy and implications.

The treatment of chronic fatigue syndrome: science and speculation.

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

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

Mindfulness-based stress reduction for people with chronic diseases.

Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia.

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

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.

Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review.

[Psychopharmacological treatment in patients with somatoform disorders and functional body syndromes].

Dose-effect of long-snake-like moxibustion for chronic fatigue syndrome: a randomized controlled trial.

eLearning improves allied health professionals' knowledge and confidence to manage medically unexplained chronic fatigue states: A randomized controlled trial.

The Efficacy and Safety of Myelophil, an Ethanol Extract Mixture of Astragali Radix and Salviae Radix, for Chronic Fatigue Syndrome: A Randomized Clinical Trial.

A randomised controlled trial of the monoaminergic stabiliser (-)-OSU6162 in treatment of myalgic encephalomyelitis/chronic fatigue syndrome.

Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT.

[Chronic fatigue syndrome treated with transcutaneous electrical acupoint stimulation: a randomized controlled trial].

Genetic variation in catechol-O-methyltransferase modifies effects of clonidine treatment in chronic fatigue syndrome.

Treatment expectations influence the outcome of multidisciplinary rehabilitation treatment in patients with CFS.

Complementary and alternative healthcare use by participants in the PACE trial of treatments for chronic fatigue syndrome.

[Moxibustion at Gaohuang (BL 43) for chronic fatigue syndrome: a randomized controlled trial].