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TreatmentPEM-relevant

Interventions

198 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 requiredHigher confidence

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).

All Studies

198 studies, sorted by review status and evidence level

E0 ConsensusPEM unclearPreliminarySystematic-ReviewEditor reviewed

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.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

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.

Interventions
E0 ConsensusPEM unclearPreliminarySystematic-ReviewEditor reviewed

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.

Interventions
E0 ConsensusPEM unclearModerate confidenceMeta-AnalysisEditor reviewed

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.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

[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.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

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.

Interventions
E0 ConsensusPEM requiredHigher confidenceGuidelineEditor reviewed

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
E0 ConsensusPEM unclearModerate confidenceSystematic-ReviewEditor reviewed

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

Cochrane, M, Mitchell, E, Hollingworth, W et al.·Applied health economics and health policy·2021

This review looked at whether ME/CFS treatments are worth the money they cost. Researchers found that cognitive behavioral therapy (CBT)—a type of talking therapy—appears to be cost-effective for some adults with ME/CFS, though results varied depending on how it was delivered. There is much less evidence for other treatments, and very little research on what works best for children with ME/CFS.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

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

You, Jianyu, Ye, Jing, Li, Haiyan et al.·Evidence-based complementary and alternative medicine : eCAM·2021

This review examined whether moxibustion—a traditional Chinese medicine treatment that applies heat to specific points on the skin—might help people with ME/CFS. The researchers looked at 15 published studies involving over 1,000 patients and found that moxibustion appeared to reduce fatigue severity more effectively than acupuncture or standard medications. However, the researchers note that the overall quality of evidence is limited, meaning we need more rigorous studies before we can be confident about these results.

Interventions
E0 ConsensusPEM unclearModerate confidenceSystematic-ReviewEditor reviewed

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.

Ahmed, S A, Mewes, J C, Vrijhoef, Hjm·Journal of health psychology·2020

This review examined 18 previous studies that tested cognitive behavioural therapy (talk therapy focused on thoughts and behaviors) and graded exercise therapy (gradually increasing physical activity) for ME/CFS. The reviewers found that most of these studies had significant problems in how they were designed and conducted, which means we cannot be confident in their results. The review highlights that better, more carefully designed studies are needed with better ways of measuring improvements.

Interventions
E0 ConsensusPEM unclearModerate confidenceSystematic-ReviewEditor reviewed

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

Mengshoel, Anne Marit, Helland, Ingrid Bergliot, Meeus, Mira et al.·International journal of qualitative studies on health and well-being·2020

This review looked at 16 European studies on non-drug treatments for ME/CFS, examining what actually helps patients and what matters most to them during treatment. Cognitive behavioral therapy (CBT) showed the most promise for reducing fatigue compared to no treatment, while rehabilitation and activity-pacing approaches showed mixed results. Importantly, patients felt most helped when their doctors truly recognized ME/CFS as a real illness and supported them, but they were often unsure what these treatments actually involved or why they were being recommended.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

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

Kim, Do-Young, Lee, Jin-Seok, Park, Samuel-Young et al.·Journal of translational medicine·2020

Researchers reviewed 55 clinical trials testing different treatments for ME/CFS involving over 6,000 patients. They found that while a few treatments showed promise—including some medications, cognitive-behavior therapy, graded exercise, and traditional therapies like acupuncture—none proved to be reliably effective across multiple studies. This review highlights that we still don't have a clearly proven treatment for ME/CFS.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

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

Zhang, Xiaoyan, Wang, Miao, Zhou, Shigao·Evidence-based complementary and alternative medicine : eCAM·2020

This review looked at research on traditional Chinese medicine (TCM) treatments for chronic fatigue syndrome over a five-year period. Researchers found that many clinical studies showed TCM may help improve CFS symptoms, but the results are still not completely clear. The review examined different TCM approaches including syndrome-based treatment, external therapies, and combinations with other treatments.

Interventions
E0 ConsensusPEM unclearPreliminaryReview-NarrativeEditor reviewed

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

Gregorowski, Anna, Simpson, Jane, Segal, Terry Y·Current opinion in pediatrics·2019

This review looked at what we currently know about ME/CFS in children and teenagers, including what might cause it, how it affects their lives, and what treatments might help. The researchers found that ME/CFS is a serious condition that varies greatly from person to person, and that we still don't fully understand what causes it or have proven treatments that work for everyone. They highlight that more research is urgently needed, especially to help the most severely affected young people.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

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

Vink, Mark, Vink-Niese, Alexandra·Health psychology open·2019

This study reviewed research on cognitive behavioural therapy (CBT) for ME/CFS and found that it helps only a small number of patients with mild symptoms experience temporary subjective fatigue improvement. The improvement didn't translate into better physical fitness, job status, or disability benefits. Safety concerns were largely unreported in the original studies, but patient reports suggest about 1 in 5 people experienced negative outcomes.

Interventions
E0 ConsensusPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

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

Geraghty, Keith J, Blease, Charlotte·Journal of health psychology·2018

This review looked at whether cognitive behavioural therapy (CBT)—a type of talk therapy focused on thoughts and behaviors—actually helps ME/CFS patients. The researchers found that CBT may help some people feel less tired in the short term, but there's little proof it works long-term or improves physical abilities. Importantly, CBT can sometimes make people feel worse if it's not done carefully, and much of any improvement might come from the therapist's skill or placebo effect rather than the therapy itself.

Interventions
E0 ConsensusPEM unclearModerate confidenceEditorialEditor reviewed

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

Vink, Mark, Vink-Niese, Alexandra·Health psychology open·2018

This analysis reviewed a major trial called FatiGo that compared two treatment approaches for ME/CFS: multidisciplinary rehabilitation (combining physical therapy, psychology, and other treatments) and cognitive behavioral therapy (CBT). While the original FatiGo trial claimed both treatments were effective, this review found serious problems with how the study was conducted and concluded that the evidence does not actually support these claims.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

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

Jones, Kathryn, Probst, Yasmine·Australian and New Zealand journal of public health·2017

Researchers reviewed 22 studies looking at whether changing what you eat could help ME/CFS symptoms. They found some promise with certain supplements like omega-3 fatty acids and D-ribose, as well as foods high in polyphenols (like berries and green tea). However, the evidence overall was limited and inconsistent—meaning we don't yet have clear dietary recommendations that work reliably for most ME/CFS patients.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

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

Wang, Taiwu, Xu, Cong, Pan, Keli et al.·BMC complementary and alternative medicine·2017

This study reviewed 31 previous research trials examining whether acupuncture and moxibustion (traditional Chinese treatments involving needles and heat) help treat ME/CFS. The researchers found that combining multiple acupuncture and moxibustion techniques appeared more effective than using just one technique, and both were more effective than sham acupuncture (fake treatment). However, the overall quality of the research studies reviewed was weak, so stronger evidence is needed before drawing firm conclusions.

Interventions
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeEditor reviewed

Pediatric chronic fatigue syndrome: current perspectives.

Crawley, Esther·Pediatric health, medicine and therapeutics·2017

This review examines ME/CFS in children, showing it is a common condition that significantly affects children and their families. The good news is that most children improve when they receive specialized treatment from doctors who understand this illness. The review summarizes what we know about how many children get ME/CFS, what factors may be involved, and what treatments have evidence supporting them.

Interventions
E0 ConsensusPEM requiredWeak / uncertainSystematic-ReviewEditor reviewed

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

Collatz, Ansel, Johnston, Samantha C, Staines, Donald R et al.·Clinical therapeutics·2016

Researchers searched for studies testing medications for ME/CFS and found 26 high-quality trials. While 10 medications showed some benefit in their respective studies, no single medication worked well for everyone with ME/CFS. This suggests that different patients may need different treatments, and more research is needed to find which medications help which patients.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

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

Smith, M E Beth, Haney, Elizabeth, McDonagh, Marian et al.·Annals of internal medicine·2015

This study reviewed 35 clinical trials testing different treatments for ME/CFS to see what actually works. The researchers found that a few treatments showed promise—particularly a drug called rintatolimod for exercise performance, and talking therapies plus graded exercise programs for improving fatigue and daily functioning—but most other treatments tested didn't have enough evidence to prove they help. Overall, doctors still need better studies to know for sure which treatments work best for different patients.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Chronic fatigue syndrome.

Cleare, Anthony J, Reid, Steven, Chalder, Trudie et al.·BMJ clinical evidence·2015

This research review looked at treatments for chronic fatigue syndrome (ME/CFS) and found that the condition affects between 0.006% and 3% of people depending on how it's diagnosed, with women more commonly affected than men. The researchers searched multiple medical databases for studies on four main treatments: antidepressants, cognitive behavioral therapy (a type of talk therapy), corticosteroids (anti-inflammatory drugs), and graded exercise therapy. They carefully reviewed 15 high-quality studies to evaluate how well these treatments work and whether they're safe.

Interventions
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

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

Wang, Yu-Yi, Li, Xin-Xue, Liu, Jian-Ping et al.·Complementary therapies in medicine·2014

This review examined 23 studies testing traditional Chinese medicine (TCM) treatments for chronic fatigue syndrome, involving 1,776 patients. The treatments included herbal medicines, acupuncture, qigong, and other TCM approaches. Most studies found that TCM helped reduce fatigue symptoms, though the quality of these studies was often poor, and it's unclear if TCM improves overall quality of life for patients.

Interventions
E0 ConsensusPEM unclearWeak / uncertainObservationalEditor reviewed

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

Kreijkamp-Kaspers, Sanne, Brenu, Ekua Weba, Marshall, Sonya et al.·Australian family physician·2011

This study looked at what medicines and supplements 94 people with ME/CFS were taking and checked what scientific evidence supported their use. The patients were using hundreds of different treatments, with antidepressants, pain relievers, sleep aids, and B vitamins being the most common. However, when researchers searched for rigorous studies proving these treatments work for ME/CFS, they found very limited evidence—only 20 good-quality trials existed for the medicines patients were using.

Interventions
E0 ConsensusPEM not requiredModerate confidenceMeta-AnalysisEditor reviewed

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

Wang, Jing-jing, Song, Yu-jing, Wu, Zhong-chao et al.·Zhen ci yan jiu = Acupuncture research·2009

This review analyzed 28 studies testing whether acupuncture helps people with ME/CFS. Researchers combined results from randomized controlled trials (the gold standard for testing treatments) and found that patients receiving acupuncture reported better outcomes than those in control groups. However, the authors note that more high-quality studies are needed to confirm these findings.

Interventions
E0 ConsensusPEM not requiredWeak / uncertainSystematic-ReviewEditor reviewed

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

Adams, Denise, Wu, Taixiang, Yang, Xunzhe et al.·The Cochrane database of systematic reviews·2009

This study looked at whether herbal medicines used in traditional Chinese medicine (TCM) could help treat chronic fatigue and ME/CFS. Researchers searched through thousands of medical studies to find high-quality tests comparing TCM herbs to placebo or standard treatments, but they found that none of the available studies were rigorous enough to draw reliable conclusions about whether these treatments actually work.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Cognitive behaviour therapy for chronic fatigue syndrome in adults.

Price, Jonathan R, Mitchell, Edward, Tidy, Elizabeth et al.·The Cochrane database of systematic reviews·2008

This review looked at 15 studies involving over 1,000 people with ME/CFS to see if cognitive behaviour therapy (CBT)—a type of talk therapy focused on thoughts and behaviors—could help reduce fatigue. Compared to usual care, CBT showed modest improvements in fatigue at the end of treatment, with 40% of people in CBT improving versus 26% in usual care. However, the benefits were less clear when researchers checked on people months later.

Interventions
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeEditor reviewed

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

Luyten, Patrick, Van Houdenhove, Boudewijn, Pae, Chi-Un et al.·Psychiatry investigation·2008

This review examines current treatments for ME/CFS and discusses what we know about what causes the condition. The authors suggest that effective treatment should be personalized to each patient's needs and focus on helping people make lasting changes to their lifestyle that restore both mental and physical balance. The review emphasizes that while treatments exist, many patients still have a poor prognosis even when receiving care.

Interventions
E0 ConsensusPEM not requiredModerate confidenceMeta-AnalysisEditor reviewed

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

Malouff, John M, Thorsteinsson, Einar B, Rooke, Sally E et al.·Clinical psychology review·2008

This study reviewed 15 previous research studies on whether cognitive behavioral therapy (CBT)—a type of talk therapy focused on thoughts and behaviors—helps people with chronic fatigue syndrome. Overall, people who received CBT showed moderate improvement in fatigue compared to those who didn't receive it. About half of the people who completed CBT no longer met the clinical criteria for severe fatigue, though some people dropped out of treatment.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

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

Cho, Hyong Jin, Hotopf, Matthew, Wessely, Simon·Psychosomatic medicine·2005

This study looked at how often ME/CFS patients improve simply from believing they will improve (the placebo effect) in clinical trials. Researchers found that the placebo response in ME/CFS is actually lower than many people assume—only about 20% of patients improved with placebo. Interestingly, patients were less likely to show placebo improvement when the treatment was psychological or psychiatric in nature, possibly because many ME/CFS patients believe their illness is physical rather than mental.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

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

Whiting, P, Bagnall, A M, Sowden, A J et al.·JAMA·2001

This review looked at 44 studies testing different treatments for ME/CFS to see which ones actually work. The researchers found that cognitive behavioral therapy (talk-based therapy) and graded exercise therapy (gradually increasing activity) showed the most promise, while other treatments like supplements and immunological therapies had unclear or limited benefits. However, the studies used different measurements and methods, making it hard to draw firm conclusions.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Cognitive behaviour therapy for adults with chronic fatigue syndrome.

Price, J R, Couper, J·The Cochrane database of systematic reviews·2000

This review examined whether cognitive behaviour therapy (CBT)—a type of talk therapy that helps people change unhelpful thinking patterns and gradually return to activities—helps adults with ME/CFS. Researchers looked at three high-quality studies and found that CBT did improve physical functioning compared to standard medical care or relaxation therapy. However, the evidence was limited to people who could attend clinic appointments; more research is needed in people with milder or more severe forms of the illness.

Interventions
E0 ConsensusPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

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

Sharpe, M·The American journal of medicine·1998

This review examines cognitive behavior therapy (CBT), a talk-based treatment that helps people change thought patterns and behaviors that may be making their fatigue worse. Research from two rigorous clinical trials shows that CBT can significantly help people with ME/CFS feel better and become more active. While most people improve, complete recovery is rare.

Interventions
E0 ConsensusPEM not requiredPreliminaryEditorialEditor reviewed

The treatment of chronic fatigue syndrome: science and speculation.

Wilson, A, Hickie, I, Lloyd, A et al.·The American journal of medicine·1994

This review examined different treatments for ME/CFS and found that the condition is complex, affecting people in various ways. No single treatment has been proven to work well for most patients over the long term. The authors suggest that the best approach combines medical care, psychological support, and symptom management tailored to each person's needs.

Interventions
E0 ConsensusPEM not requiredModerate confidenceMeta-AnalysisEditor reviewed

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.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Mindfulness-based stress reduction for people with chronic diseases.

Merkes, Monika·Australian journal of primary health·2010

This review looked at 15 studies testing whether mindfulness meditation programs (called MBSR) help people with chronic illnesses feel better. The studies included people with ME/CFS, fibromyalgia, chronic pain, and other long-term conditions. All 15 studies found that people who participated in these programs experienced improvements in their symptoms, mood, and quality of life, with no negative effects reported.

Interventions
E0 ConsensusPEM unclearPreliminarySystematic-ReviewEditor reviewed

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

Porter, Nicole S, Jason, Leonard A, Boulton, Aaron et al.·Journal of alternative and complementary medicine (New York, N.Y.)·2010

This review looked at 70 research studies testing complementary and alternative treatments for ME/CFS and fibromyalgia. The researchers found that most studies (86%) reported at least some positive effect from the treatments tested, with acupuncture, meditation practices, and supplements like magnesium and L-carnitine showing the most promise. However, the quality of these studies varied widely, making it difficult to draw firm conclusions about which treatments actually work.

Interventions
E0 ConsensusPEM unclearModerate confidenceMeta-AnalysisEditor reviewed

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.

Interventions
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

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

Wortman, Margreet S H, Lokkerbol, Joran, van der Wouden, Johannes C et al.·PloS one·2018

This study looked at 39 research projects to find out which treatments for long-lasting unexplained symptoms—including chronic fatigue syndrome—work best and offer good value for money. The researchers found that group-based treatments (where patients meet together) tend to be more cost-effective than one-on-one treatments. However, the studies they reviewed were quite different from each other, making it hard to compare results directly.

Interventions
E0 ConsensusPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

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

Kapfhammer, H P·Der Nervenarzt·2012

This review looked at how psychiatric medications (mainly antidepressants) might help people with physical symptoms that doctors cannot fully explain medically. The researchers found that antidepressants can reduce pain and other symptoms in conditions like fibromyalgia and irritable bowel syndrome, but they found no clear proven medication strategy for chronic fatigue syndrome (ME/CFS) yet.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

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

Luo, Hong, Gong, Rui, Zheng, Rui et al.·Journal of translational medicine·2023

This study tested whether longer sessions of moxibustion (a traditional Chinese medicine heat treatment) might work better than shorter sessions for chronic fatigue syndrome. Sixty women with CFS were treated either 60 minutes or 30 minutes per session, three times per week for four weeks. The 60-minute sessions produced greater improvements in fatigue and other symptoms, and thermal imaging showed better changes in body heat patterns with the longer treatment.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

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

Jones, Matthew D, Casson, Sally M, Barry, Benjamin K et al.·Journal of psychosomatic research·2023

This study tested whether an online training program could help doctors and therapists better understand and treat chronic fatigue conditions. Allied health professionals who completed the 4-week online course significantly improved their knowledge and confidence in managing these patients, compared to those who didn't receive training. Most participants found the course helpful and would recommend it to others.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

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

Joung, Jin-Yong, Lee, Jin-Seok, Cho, Jung-Hyo et al.·Frontiers in pharmacology·2019

Researchers tested a herbal supplement called Myelophil (made from two plant extracts) in 97 people with ME/CFS over 12 weeks. Overall, the supplement didn't significantly reduce fatigue compared to placebo. However, in people with severe fatigue symptoms at the start, Myelophil did show meaningful improvement in fatigue levels and quality of life. The treatment was safe with no serious side effects reported.

Interventions
E1 ReplicatedPEM unclearPreliminaryRCTEditor reviewed

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

Nilsson, Marie Karin Lena, Zachrisson, Olof, Gottfries, Carl-Gerhard et al.·Acta neuropsychiatrica·2018

Researchers tested a drug called (-)-OSU6162 to see if it could help people with ME/CFS feel less mentally tired. Sixty-two patients received either the drug or a placebo (dummy pill) for 2 weeks. While both groups felt somewhat better during treatment, the drug did not work significantly better than placebo overall. Interestingly, the drug appeared to help more in patients who were also taking antidepressants.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceEditorialEditor reviewed

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

Wilshire, Carolyn E, Kindlon, Tom, Courtney, Robert et al.·BMC psychology·2018

This study re-examined a large, well-known trial called PACE that tested whether exercise therapy and talking therapy could help people with ME/CFS. When researchers checked the original study data using the methods that were promised before the trial started, they found much weaker benefits than originally reported. The treatments did not clearly work better than standard care, recovery rates were very low, and improvements seemed to fade after two years.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

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

Li, Jinxia, Xie, Jingjun, Pan, Zhongqiang et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2017

Researchers tested a treatment called transcutaneous electrical acupoint stimulation (TEAS)—a non-invasive electrical stimulation applied to specific acupuncture points on the body—in 89 people with ME/CFS. After 4 weeks of daily treatment, the group receiving real TEAS showed significant improvements in fatigue and overall symptoms, while the group receiving sham (fake) TEAS did not improve. The treatment was well-tolerated with no reported side effects.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

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

Hall, K T, Kossowsky, J, Oberlander, T F et al.·The pharmacogenomics journal·2016

This study tested whether a blood pressure medication called clonidine helps people with ME/CFS, and found that it worked differently depending on patients' genes. Specifically, people with a certain genetic variation in a gene called COMT had worse outcomes (fewer steps walked, worse sleep, lower quality of life) when taking clonidine, while those with a different version of the gene showed no improvement or worsening. This suggests that genetic testing might help doctors figure out which patients should avoid this medication.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

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

Vos-Vromans, D C W M, Huijnen, I P J, Rijnders, L J M et al.·Journal of psychosomatic research·2016

This study tested whether patients' expectations about treatment affect how well they recover from ME/CFS. Researchers gave 122 patients either cognitive behavioral therapy (CBT) or multidisciplinary rehabilitation treatment (MRT) and measured their expectations before starting. They found that for patients receiving MRT, having positive expectations was linked to better outcomes in fatigue and physical quality of life—but this connection was not found in the CBT group.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceObservationalEditor reviewed

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

Lewith, G, Stuart, B, Chalder, T et al.·Journal of psychosomatic research·2016

This study looked at how many people with ME/CFS use complementary and alternative medicine (CAM)—such as herbal supplements, acupuncture, or other non-standard treatments—and whether these helped their symptoms. Researchers found that 70% of study participants used some form of CAM at the start, but using CAM was not associated with meaningful improvements in fatigue or physical function over the course of the study.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

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

Tian, Liang, Wang, Jinhai, Luo, Chenglin et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2015

This study tested whether moxibustion (a traditional Chinese medicine technique using heated mugwort) applied to a specific acupuncture point on the back could help people with ME/CFS feel less tired. Seventy-two patients received either moxibustion or traditional acupuncture at the same points for three treatment courses. The moxibustion group showed greater improvement in fatigue scores compared to the acupuncture group.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

A randomized, placebo-controlled, double-blinded trial of duloxetine in the treatment of general fatigue in patients with chronic fatigue syndrome.

Arnold, Lesley M, Blom, Thomas J, Welge, Jeffrey A et al.·Psychosomatics·2015

This study tested whether duloxetine, a medication that affects mood and pain, could help reduce fatigue in people with ME/CFS. Over 12 weeks, 60 patients either took duloxetine or a placebo (dummy pill). While the medication did not significantly improve general fatigue compared to placebo, it did help some people with mental fatigue, pain, and overall symptom severity.

Interventions
E1 ReplicatedPEM unclearPreliminaryRCTEditor reviewed

The feasibility and acceptability of conducting a trial of specialist medical care and the Lightning Process in children with chronic fatigue syndrome: feasibility randomized controlled trial (SMILE study).

Crawley, Esther, Mills, Nicola, Beasant, Lucy et al.·Trials·2013

This study tested whether it was possible to run a fair comparison trial between standard medical care and a treatment called the Lightning Process for children with ME/CFS. Researchers recruited 56 young people aged 12-18 from a specialist clinic and found that running this type of trial was workable and acceptable to patients. The study helped identify practical changes to improve how future trials should be conducted.

Interventions
E1 ReplicatedPEM unclearPreliminaryRCTEditor reviewed

Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study.

Rimes, Katharine A, Wingrove, Janet·Clinical psychology & psychotherapy·2013

This study tested whether a mindfulness and meditation-based therapy could help people with ME/CFS who weren't getting better with standard cognitive behaviour therapy (CBT) alone. Researchers randomly gave some patients the new mindfulness therapy while others waited, then compared how they did. The mindfulness therapy helped reduce fatigue and improved mood, and patients found it helpful and acceptable.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Moderators of the treatment response to guided self-instruction for chronic fatigue syndrome.

Tummers, Marcia, Knoop, Hans, van Dam, Arno et al.·Journal of psychosomatic research·2013

This study looked at which ME/CFS patients benefit most from a self-guided treatment that focuses on changing thoughts and behaviors related to fatigue. Researchers found that younger patients, those without significant depression, and those who don't tend to avoid activities responded better to this treatment. Patients with severe depression or who are older may need different or additional types of help.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Recovery from chronic fatigue syndrome after treatments given in the PACE trial.

White, P D, Goldsmith, K, Johnson, A L et al.·Psychological medicine·2013

This study looked at how many ME/CFS patients got better after receiving different treatments over one year. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) helped about 22% of patients recover, while adaptive pacing therapy and standard medical care alone helped only about 7-8%. CBT and GET were significantly more effective than the other treatments tested.

Interventions
E1 ReplicatedPEM unclearModerate confidenceRCTEditor reviewed

A double-blind, placebo-controlled, randomized, clinical trial of the TLR-3 agonist rintatolimod in severe cases of chronic fatigue syndrome.

Strayer, David R, Carter, William A, Stouch, Bruce C et al.·PloS one·2012

This study tested whether a drug called rintatolimod (a molecule designed to activate immune responses) could help people with severe ME/CFS. Over 230 patients received either the drug or a placebo twice a week for 40 weeks. Patients who received rintatolimod improved their exercise tolerance by about 21%, and they also needed fewer medications to manage their symptoms.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

[Observation on therapeutic effect of acupuncture of Back-shu acupoints for chronic fatigue syndrome patients].

Zhang, Wei, Liu, Zhi-Shun, Xu, Hai-Rong et al.·Zhen ci yan jiu = Acupuncture research·2011

This study tested whether acupuncture at specific points on the back could help people with chronic fatigue syndrome (CFS). Researchers treated 120 patients with either real acupuncture at traditional healing points or fake acupuncture at non-therapeutic locations. Both groups showed some improvement in fatigue and quality of life, but the real acupuncture group had better results and higher satisfaction after 4 weeks and 3 months.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

Amisulpride vs. fluoxetine treatment of chronic fatigue syndrome: a pilot study.

Pardini, Matteo, Guida, Silvia, Primavera, Alberto et al.·European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology·2011

This study tested two medications in 40 ME/CFS patients without depression: amisulpride (a low-dose psychiatric medication) and fluoxetine (an antidepressant). After 12 weeks, patients taking amisulpride reported feeling less fatigued and had fewer body aches, while those taking fluoxetine saw little improvement. Both medications were well-tolerated, suggesting amisulpride might be worth exploring further as a treatment option.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

[Randomized controlled study on acupuncture treatment for chronic fatigue syndrome].

Chen, Xing-Hua, Li, Lu-Qian, Zhang, Wen et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2010

This study tested whether acupuncture could help people with chronic fatigue syndrome (CFS) feel less tired. Ninety patients were divided into two groups: one received acupuncture at specific points on the head and neck, while the other received glucose and herbal injections. Both treatments reduced fatigue, but acupuncture worked better than the injection treatment.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial.

Knoop, Hans, van der Meer, Jos W M, Bleijenberg, Gijs·The British journal of psychiatry : the journal of mental science·2008

This study tested whether simple self-help instructions based on cognitive-behavioural therapy, combined with email support, could help people with ME/CFS. Researchers compared 85 people who received this intervention with 86 people on a waiting list. The results showed that people who received the self-instructions experienced meaningful reductions in fatigue and improved daily functioning, particularly those with less severe symptoms.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial.

Stubhaug, Bjarte, Lie, Stein Atle, Ursin, Holger et al.·The British journal of psychiatry : the journal of mental science·2008

This study tested whether a structured talk therapy program (cognitive-behavioural therapy) and/or a medication called mirtazapine could help people with chronic fatigue. Seventy-two patients were divided into groups receiving either the therapy program, the medication, or a placebo (fake pill). The therapy program worked best in the first 12 weeks, but when patients combined therapy first with medication afterward, they showed the most improvement by week 24.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

The effect of acclydine in chronic fatigue syndrome: a randomized controlled trial.

The, Gerard K H, Bleijenberg, Gijs, van der Meer, Jos W M·PLoS clinical trials·2007

Researchers tested whether a food supplement called Acclydine could help people with ME/CFS by increasing levels of a growth factor called IGF1. They compared 57 ME/CFS patients to healthy controls and found no difference in IGF1 levels between the groups. After 14 weeks of treatment, Acclydine did not improve fatigue, function, or IGF1 levels any better than placebo.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceObservationalEditor reviewed

Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Knoop, Hans, Stulemeijer, Maja, Prins, Judith B et al.·Behaviour research and therapy·2007

This study looked at whether cognitive behavioural therapy (CBT)—a type of talk therapy that helps change thought patterns and behaviors—could reduce pain in ME/CFS patients, even though it wasn't specifically designed to treat pain. Researchers found that patients who recovered from fatigue through CBT also experienced significant reductions in pain severity and the number of body areas affected by pain.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

The therapeutic effects of electrical acupuncture and auricular-plaster in 32 cases of chronic fatigue syndrome.

Yuemei, Li, Hongping, Liu, Shulan, Feng et al.·Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan·2006

This study tested whether electrical acupuncture combined with auricular plaster (a small patch placed on the ear) could help people with chronic fatigue syndrome. The treatment group showed improvement in about 94% of cases, compared to 75% in the group taking a standard medicine (hydrocortisone). The results suggest this traditional Chinese medicine approach may work better than the medication tested.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme.

O'Dowd, H, Gladwell, P, Rogers, C A et al.·Health technology assessment (Winchester, England)·2006

This study compared three approaches for managing ME/CFS: group cognitive behavioural therapy (CBT), education and support groups, and standard medical care. After 12 months, patients who received CBT showed improvements in mental health, fatigue levels, and walking ability compared to standard care, though improvements were modest and many patients did not fully recover.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial.

Stulemeijer, Maja, de Jong, Lieke W A M, Fiselier, Theo J W et al.·BMJ (Clinical research ed.)·2005

This study tested whether cognitive behaviour therapy (CBT)—a type of talking therapy that helps people change unhelpful thinking patterns and gradually return to activities—could help teenagers with ME/CFS. Teenagers who received 10 sessions of CBT over five months showed greater improvements in fatigue, ability to do daily activities, and school attendance compared to those who waited for treatment. The therapy was tailored based on whether teenagers were mostly active or inactive.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome.

Prins, Judith, Bleijenberg, Gijs, Rouweler, Eufride Klein et al.·The British journal of psychiatry : the journal of mental science·2005

This study looked at whether having a mental health condition (like depression or anxiety) affects how well cognitive-behavioural therapy (CBT) works for ME/CFS. Researchers interviewed 270 people with ME/CFS about their psychiatric history and tracked their recovery after CBT treatment. Surprisingly, they found that people with mental health diagnoses improved just as much as those without them, suggesting that having a psychiatric condition doesn't prevent CBT from helping with ME/CFS symptoms.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceObservationalEditor reviewed

Predictors of outcome following treatment for chronic fatigue.

Darbishire, Lucy, Seed, Paul, Ridsdale, Leone·The British journal of psychiatry : the journal of mental science·2005

This study looked at 105 people with fatigue who received either exercise therapy or talking therapy to see which patients improved and which didn't. The researchers found that having a formal diagnosis of chronic fatigue syndrome made it much less likely that people would improve with these treatments. The effect was even stronger if patients had severe limitations in daily activities or believed their illness would have serious consequences.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Quality of life and symptom severity for individuals with chronic fatigue syndrome: findings from a randomized clinical trial.

Taylor, Renée R·The American journal of occupational therapy : official publication of the American Occupational Therapy Association·2004

This study tested whether a rehabilitation program designed with input from ME/CFS patients could help people feel better and reduce their symptoms. Forty-seven people with ME/CFS were split into two groups—one started the program right away while the other waited. Researchers measured symptom severity and quality of life before, during, and after the program. The group that received the program showed meaningful improvements in both how severe their symptoms felt and their overall quality of life compared to the group that waited.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

Randomized controlled trial of Siberian ginseng for chronic fatigue.

Hartz, A J, Bentler, S, Noyes, R et al.·Psychological medicine·2004

This study tested whether Siberian ginseng could reduce fatigue in people with chronic fatigue lasting at least 6 months. Ninety-six people took either Siberian ginseng or a placebo pill for 2 months. While both groups improved during the study, the ginseng did not work better than placebo overall, though it showed some promise in people with moderate (not severe) fatigue.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome.

Severens, J L, Prins, J B, van der Wilt, G J et al.·QJM : monthly journal of the Association of Physicians·2004

This study compared the cost and effectiveness of cognitive behaviour therapy (CBT), support groups, and usual care for ME/CFS patients over 14 months. CBT helped more patients improve (27% at 14 months) compared to support groups (11%) and usual care (20%), and was less expensive than support groups. However, compared to doing nothing special, CBT cost about €20,500 per patient who showed meaningful improvement.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Efficacy of cognitive-behavioural therapy by general practitioners for unexplained fatigue among employees: Randomised controlled trial.

Huibers, Marcus J H, Beurskens, Anna J H M, Van Schayck, Constant P et al.·The British journal of psychiatry : the journal of mental science·2004

This study tested whether a short course of talking therapy (cognitive-behavioural therapy) delivered by general doctors could help employees with persistent, unexplained fatigue who were on sick leave. Over one year, patients who received 5-7 sessions of this therapy showed no greater improvement in fatigue, work absences, or recovery than those who received no treatment. The therapy did not prove helpful for this type of fatigue.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Effect of galantamine hydrobromide in chronic fatigue syndrome: a randomized controlled trial.

Blacker, C V Russell, Greenwood, David T, Wesnes, Keith A et al.·JAMA·2004

Researchers tested whether a medication called galantamine hydrobromide could help people with ME/CFS by comparing it to a placebo (dummy pill) in 434 patients across multiple countries. After 16 weeks of treatment, the medication did not work better than placebo for relieving fatigue, sleep problems, pain, or overall quality of life. This study shows that galantamine is not an effective treatment for ME/CFS.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for chronic fatigue syndrome.

Santaella, María L, Font, Ivonne, Disdier, Orville M·Puerto Rico health sciences journal·2004

This study tested whether a supplement called NADH could help people with ME/CFS feel better compared to standard nutritional supplements and counseling. Over 24 months, 12 patients received NADH while a comparison group received conventional treatment. During the first three months, patients taking NADH showed significant improvement in their symptoms, but by later time points, both groups improved at similar rates.

Interventions
E1 ReplicatedPEM not requiredPreliminaryProtocolEditor reviewed

Efficacy of distant healing--a proposal for a four-armed randomized study (EUHEALS).

Walach, H, Bösch, H, Haraldsson, E et al.·Forschende Komplementarmedizin und klassische Naturheilkunde = Research in complementary and natural classical medicine·2002

This study tested whether distant healing—treatment from healers who don't meet you in person but work with your name and photo—might help people with ME/CFS and related conditions. Researchers randomly assigned 400 patients to receive healing, no healing, or healing without knowing about it, to see if the treatment itself works or if belief in it creates the benefit. They measured mental health over 6 months to see if distant healing made a difference.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceLongitudinalEditor reviewed

Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study.

Deale, A, Husain, K, Chalder, T et al.·The American journal of psychiatry·2001

Researchers compared two types of therapy for ME/CFS: cognitive behavior therapy (CBT, which focuses on changing thought patterns and gradually increasing activity) and relaxation therapy. After 5 years, 68% of people who received CBT reported feeling much or very much improved, compared to 36% who received relaxation therapy. However, neither therapy fully eliminated fatigue symptoms, and some patients found it hard to keep improving after their regular treatment ended.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial.

Prins, J B, Bleijenberg, G, Bazelmans, E et al.·Lancet (London, England)·2001

This study tested whether cognitive behaviour therapy (CBT)—a type of talking therapy that focuses on thoughts and behaviours—helps people with ME/CFS. Researchers compared CBT with support groups and no treatment across three hospitals, following 278 patients for 14 months. CBT showed modest benefits for fatigue and daily functioning compared to the other groups, though only about one-third to one-half of patients experienced meaningful improvement.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

A randomized, double-blind placebo-controlled trial of moclobemide in patients with chronic fatigue syndrome.

Hickie, I B, Wilson, A J, Wright, J M et al.·The Journal of clinical psychiatry·2000

This study tested whether a medication called moclobemide could help people with ME/CFS. Ninety patients received either moclobemide or a placebo for several weeks. About half of those taking moclobemide felt better, compared to one-third taking placebo—mainly reporting more energy and vigor rather than improvement in mood. The medication appeared to work best for people who also had immune system problems.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Illness beliefs and treatment outcome in chronic fatigue syndrome.

Deale, A, Chalder, T, Wessely, S·Journal of psychosomatic research·1998

This study examined whether what ME/CFS patients believe about the cause of their illness affects how well they recover with treatment. Researchers found that patients' beliefs about whether their condition was physical didn't predict treatment success. However, patients who changed their views about avoiding exercise and activity—and actually started doing more—improved more with cognitive-behavior therapy than with relaxation alone.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Randomised, double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome.

Vercoulen, J H, Swanink, C M, Zitman, F G et al.·Lancet (London, England)·1996

This study tested whether fluoxetine (an antidepressant medication) could help people with ME/CFS feel better. Researchers gave 96 patients either fluoxetine or a placebo for 8 weeks and measured changes in fatigue, mood, sleep, and physical activity. The medication did not improve any of these symptoms compared to placebo, whether or not patients were depressed.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double-blind, placebo-controlled trial.

Lloyd, A R, Hickie, I, Brockman, A et al.·The American journal of medicine·1993

This study tested whether two treatments—an immune-boosting extract and cognitive-behavioral therapy (a talk therapy focused on thoughts and behaviors)—could help people with ME/CFS. Ninety patients received either these treatments, a placebo, or combinations of both in a blinded trial. Neither treatment worked better than placebo, suggesting that the improvement some patients experienced may have been due to placebo effect or natural recovery rather than the specific treatments tested.

Interventions
E1 ReplicatedPEM not requiredWeak / uncertainRCTEditor reviewed

Liver extract-folic acid-cyanocobalamin vs placebo for chronic fatigue syndrome.

Kaslow, J E, Rucker, L, Onishi, R·Archives of internal medicine·1989

Researchers tested a liver extract injection containing folic acid and B12 (a treatment some doctors in Southern California were recommending for ME/CFS) against a placebo injection in 15 ME/CFS patients. Both the real treatment and placebo improved patients' symptoms and function, but there was no meaningful difference between the two groups. The strong response to placebo suggests that patients' expectations and other non-chemical factors may play a significant role in how they experience symptom improvement.

Interventions
E1 ReplicatedPEM unclearModerate confidenceRCTEditor reviewed

Amygdala and Insula Retraining (AIR) Significantly Reduces Fatigue and Increases Energy in People with Long COVID.

Toussaint, Loren L, Bratty, Alexandra J·Evidence-based complementary and alternative medicine : eCAM·2023

This study tested whether a brain retraining program called Amygdala and Insula Retraining (AIR) could help people with Long COVID feel less exhausted and have more energy. Over 3 months, people who did the AIR program reported significantly less fatigue and more energy compared to a control group that received a different wellness program. The AIR group showed roughly twice the improvement in energy levels and four times the improvement in fatigue compared to the control group.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Imipramine versus placebo for multiple functional somatic syndromes (STreSS-3): a double-blind, randomised study.

Agger, Johanne L, Schröder, Andreas, Gormsen, Lise K et al.·The lancet. Psychiatry·2017

This study tested whether a low-dose antidepressant called imipramine could help people who have multiple overlapping chronic conditions like ME/CFS and irritable bowel syndrome. Over 10 weeks, patients taking imipramine were more likely to report feeling better (53%) compared to those taking placebo (25%), but imipramine caused more side effects, particularly moderate ones like dry mouth and dizziness.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Effect of ondansetron, a 5-HT3 receptor antagonist, on fatigue in chronic hepatitis C: a randomised, double blind, placebo controlled study.

Piche, T, Vanbiervliet, G, Cherikh, F et al.·Gut·2005

This study tested whether a medication called ondansetron, which affects serotonin in the brain, could reduce fatigue in people with chronic hepatitis C. Thirty-six patients took either ondansetron or a placebo pill for one month and were then observed for another month. Ondansetron significantly improved fatigue scores by more than 30% within two weeks and maintained this improvement, while placebo did not.

Interventions
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

Biofeedback-based psychophysiological treatment in a primary care setting: an initial feasibility study.

Ryan, Meredith, Gevirtz, Richard·Applied psychophysiology and biofeedback·2004

This study tested whether biofeedback—a technique that helps people become aware of and control their body's responses—could help patients with chronic fatigue syndrome and similar conditions in a regular doctor's office. Nineteen patients received biofeedback treatment while 30 others received usual care. Patients who completed the biofeedback treatment reported fewer and less severe symptoms, and the group also had lower medical costs after treatment.

Interventions
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

L-carnitine decreases severity and type of fatigue induced by interferon-alpha in the treatment of patients with hepatitis C.

Neri, Sergio, Pistone, Giovanni, Saraceno, Barbara et al.·Neuropsychobiology·2003

This study tested whether a supplement called L-carnitine could reduce fatigue caused by interferon-alpha treatment in people with hepatitis C. Fifty patients received either interferon alone or interferon plus L-carnitine daily. Patients taking the supplement experienced significantly less physical and mental fatigue, and their fatigue was less severe, particularly in the first three months of treatment.

Interventions
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Medication use and symptomology in North American women with myalgic encephalomyelitis/chronic fatigue syndrome.

Pochakom, Angela, MacNevin, Gillian, Madden, Robyn F et al.·Frontiers in medicine·2025

This study surveyed 135 women with ME/CFS in North America to understand what medications they use and how these relate to their symptoms and daily functioning. Most participants were taking an average of 3 medications for ME/CFS-related symptoms, with pain medications being the most common, followed by psychiatric and immune-related medications. Interestingly, the study found a U-shaped pattern: both people using very few medications and those using many medications reported lower physical functioning, while moderate medication use was associated with better functioning.

Interventions
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Predictors of treatment response trajectories to cognitive behavioral therapy for chronic fatigue syndrome: A cohort study.

Van Oudenhove, Lukas, Debyser, Soetkin, Vergaelen, Elfi et al.·Journal of psychosomatic research·2024

This study followed 297 people with ME/CFS who received cognitive behavioral therapy (CBT) to see how their fatigue improved over time. Researchers found that people responded very differently to treatment: some improved significantly, some improved a little, and some didn't improve at all. People who started treatment with higher anxiety, depression, stress, and physical symptoms—and lower mood—were less likely to benefit from CBT.

Interventions
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Treatments of chronic fatigue syndrome and its debilitating comorbidities: a 12-year population-based study.

Leong, Kam-Hang, Yip, Hei-Tung, Kuo, Chien-Feng et al.·Journal of translational medicine·2022

This study looked at over 12,000 people in Taiwan with ME/CFS and compared them to an equal number of similar people without the condition. Researchers found that people with ME/CFS are much more likely to also have depression, anxiety, sleep problems, and certain other illnesses like diabetes and rheumatoid arthritis. The study also found that doctors commonly prescribed antidepressants, anti-anxiety medications, pain relievers, and recommended exercise and therapy—treatments that earlier research suggested might help with ME/CFS symptoms.

Interventions
E2 ModeratePEM unclearPreliminaryObservationalEditor reviewed

Off label use of Aripiprazole shows promise as a treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a retrospective study of 101 patients treated with a low dose of Aripiprazole.

Crosby, L D, Kalanidhi, S, Bonilla, A et al.·Journal of translational medicine·2021

This study looked back at medical records of 101 ME/CFS patients who were prescribed a low dose of aripiprazole, a medication typically used for other conditions. The researchers found that some patients reported improvements in their symptoms. While these results are encouraging, the study design means we need to be cautious about how much weight to give these findings.

Interventions
E2 ModeratePEM unclearPreliminaryObservationalEditor reviewed

Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study.

Rekeland, Ingrid G, Fosså, Alexander, Lande, Asgeir et al.·Frontiers in medicine·2020

Researchers tested whether cyclophosphamide, a chemotherapy drug, could help people with ME/CFS based on observations that some patients improved after cancer treatment. Forty patients received six infusions of this drug over six months, with check-ins lasting up to four years. More than half the patients reported meaningful improvements in fatigue and physical activity, with many staying better even years later.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK.

Adamson, James, Ali, Sheila, Santhouse, Alastair et al.·Journal of the Royal Society of Medicine·2020

This study looked at whether cognitive behavioural therapy (CBT)—a type of talk therapy focused on changing thoughts and behaviors—helps people with ME/CFS feel better in a real-world clinic setting. Researchers tracked nearly 1,000 patients receiving CBT and found that most improved in fatigue, physical functioning, and social life, with 85% reporting they felt better and 90% satisfied with treatment.

Interventions
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

The Relationship Between Childhood Trauma and the Response to Group Cognitive-Behavioural Therapy for Chronic Fatigue Syndrome.

De Venter, Maud, Illegems, Jela, Van Royen, Rita et al.·Frontiers in psychiatry·2020

This study looked at whether people with ME/CFS who experienced trauma in childhood respond differently to a specific talking therapy called cognitive-behavioural therapy (CBT). Researchers followed 105 patients receiving group CBT sessions over 9-12 months and tracked their fatigue levels and physical function at different time points. They found that having a history of childhood trauma did not affect how well people improved with CBT.

Interventions
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Prediction of long-term outcome after cognitive behavioral therapy for chronic fatigue syndrome.

Janse, Anthonie, Bleijenberg, Gijs, Knoop, Hans·Journal of psychosomatic research·2019

This study followed 511 ME/CFS patients for up to 10 years after they completed cognitive behavioral therapy (CBT) to see which factors predicted who would recover better long-term. Researchers found that patients who started with less severe fatigue, had symptoms for a shorter time before treatment, and felt more in control of their fatigue tended to have better outcomes years later. The study suggests that maximizing improvements during treatment and addressing pain may be important for lasting recovery.

Interventions
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Symptoms of chronic fatigue syndrome/myalgic encephalopathy are not determined by activity pacing when measured by the chronic pain coping inventory.

Thompson, D P, Antcliff, D, Woby, S R·Physiotherapy·2018

This study looked at whether activity pacing—a common strategy where people with ME/CFS carefully manage their activity levels to avoid worsening symptoms—actually helps reduce pain, fatigue, or disability. Researchers surveyed 114 ME/CFS patients and tracked 35 others through a symptom management program. They found no clear link between how much patients used pacing and their symptom levels, suggesting that pacing alone may not be the key factor in controlling ME/CFS symptoms.

Interventions
E2 ModeratePEM unclearPreliminaryObservationalEditor reviewed

Why do some ME/CFS patients benefit from treatment with sodium dichloroacetate, but others do not?

Comhaire, Frank·Medical hypotheses·2018

This study looked at why some ME/CFS patients improve when taking sodium dichloroacetate (DCA), a drug that helps mitochondria—the energy centers of cells—work better, while others don't benefit at all. By examining 35 ME/CFS patients, researchers found 6 specific patient characteristics that could predict who would respond well to DCA treatment. These findings suggest doctors might be able to identify which patients are most likely to benefit from this treatment before they start taking it.

Interventions
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Long-term follow-up after cognitive behaviour therapy for chronic fatigue syndrome.

Janse, Anthonie, Nikolaus, Stephanie, Wiborg, Jan F et al.·Journal of psychosomatic research·2017

This study followed 511 people for up to 10 years after they completed cognitive behaviour therapy (CBT) for ME/CFS. While about 70% of people maintained improved physical function, fatigue levels increased somewhat over time, and some people experienced a return of severe fatigue and activity limitations. The results suggest CBT can help many people in the long term, but not everyone stays better.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands.

Worm-Smeitink, M, Nikolaus, S, Goldsmith, K et al.·Journal of psychosomatic research·2016

This study compared how well cognitive behaviour therapy (CBT) worked for ME/CFS patients at two different treatment centers—one in the Netherlands and one in the UK. Both centers used CBT but with slightly different approaches. The Dutch center saw larger improvements in fatigue, physical functioning, and ability to work or socialize compared to the UK center. The researchers found that differences in how patients were treated, rather than differences in the patients themselves, likely explained why one center had better results.

Interventions
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

A UK based review of recommendations regarding the management of chronic fatigue syndrome.

Mallet, Miriam, King, Eleanor, White, Peter D·Journal of psychosomatic research·2016

This study looked at what different organizations in the UK recommend for treating ME/CFS. Researchers compared advice from patient support groups with advice from medical doctors and textbooks. They found major disagreements: patient groups strongly recommended complementary therapies (74% vs 16% for medical sources) and pacing strategies (91% vs 50%), while doctors more strongly recommended rehabilitation therapies (94% vs 28%). These different messages may confuse patients and affect how well treatments actually work.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome.

Fernie, Bruce A, Murphy, Gabrielle, Wells, Adrian et al.·Behavioural and cognitive psychotherapy·2016

This study tested whether two common treatments for ME/CFS—cognitive behavioral therapy (CBT) and graded exercise therapy (GET)—work equally well in real-world clinical settings. Researchers found that both treatments reduced fatigue, anxiety, and depression, and improved physical functioning similarly. They also discovered that changes in how patients think about their symptoms (measured by a questionnaire) were linked to improvements in fatigue, regardless of which treatment they received.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Chronic fatigue syndrome: comparing outcomes in White British and Black and minority ethnic patients after cognitive-behavioural therapy.

Ingman, Tom, Ali, Sheila, Bhui, Kamaldeep et al.·The British journal of psychiatry : the journal of mental science·2016

This study looked at whether cognitive-behavioural therapy (CBT)—a talking therapy that helps change thought patterns and behaviours—works equally well for ME/CFS patients from Black and minority ethnic (BME) backgrounds compared to White British patients. Both groups showed significant improvements in fatigue, physical functioning, and ability to work or socialise after CBT treatment. Importantly, BME patients improved despite starting with more negative beliefs about their condition and more avoidance behaviours.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states.

Sandler, C X, Hamilton, B A, Horsfield, S L et al.·Internal medicine journal·2016

This study tested a 12-week treatment program combining talk therapy (CBT) and supervised exercise for people with chronic fatigue. The program helped about 35% of patients feel significantly better, with improvements lasting at least 6 months. However, some patients (especially men and those with higher pain levels) were less likely to improve, and a small number actually felt worse.

Interventions
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Functional level of patients with chronic fatigue syndrome reporting use of alternative vs. traditional treatments.

Wise, Shelby, Jantke, Rachel, Brown, Abigail et al.·Fatigue : biomedicine, health & behavior·2015

This study looked at 97 ME/CFS patients to compare how well they were functioning based on the treatments they used. Patients were divided into three groups: those using only complementary/alternative medicine (CAM), those using only traditional medicine, and those using both. The study found that patients using CAM alone had better social functioning and fewer psychiatric diagnoses compared to the other groups.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

The role of the partner and relationship satisfaction on treatment outcome in patients with chronic fatigue syndrome.

Verspaandonk, J, Coenders, M, Bleijenberg, G et al.·Psychological medicine·2015

This study looked at how a patient's partner and their relationship quality affect how well cognitive behavioural therapy (CBT) works for ME/CFS. Researchers found that when partners were overly helpful or protective (called 'solicitous responses'), patients were less likely to improve significantly from their fatigue and disability. The study suggests that addressing how partners respond to the illness during treatment may be important for better outcomes.

Interventions
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia.

Regland, Björn, Forsmark, Sara, Halaouate, Lena et al.·PloS one·2015

This study looked at 38 ME/CFS patients who were receiving vitamin B12 injections and oral folic acid to see how well this treatment worked for them. Patients who improved the most received more frequent injections at higher doses, took more folic acid, and were less likely to use strong pain medications like opioids. The researchers found that this treatment combination showed real benefits for some patients, particularly when carefully matched to individual needs.

Interventions
E2 ModeratePEM not requiredPreliminaryRegistry-ResourceEditor reviewed

Improved management of primary chronic fatigue syndrome with the supplement French oak wood extract (Robuvit®): a pilot, registry evaluation.

Belcaro, G, Cornelli, U, Luzzi, R et al.·Panminerva medica·2014

This small study tested whether a supplement made from French oak wood extract (Robuvit®) could help people with chronic fatigue syndrome (CFS) when combined with a structured management plan. About half of the 91 participants received the supplement for 6 months while the other half followed the management plan alone. The supplement group showed greater improvements in fatigue symptoms and mood compared to the management-only group, and no side effects were reported.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice.

Flo, Elisabeth, Chalder, Trudie·Behaviour research and therapy·2014

This study looked at how many people with ME/CFS improved after receiving cognitive behavioural therapy (CBT) in a regular medical clinic. About 37.5% of patients no longer met the criteria for ME/CFS after 6 months, and 18.3% experienced full recovery. The researchers found that people were less likely to recover if they were older, had higher depression, struggled with work and social activities, or had unhelpful beliefs about their emotions.

Interventions
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

The role of the therapeutic relationship in cognitive behaviour therapy for chronic fatigue syndrome.

Heins, Marianne J, Knoop, Hans, Bleijenberg, Gijs·Behaviour research and therapy·2013

This study looked at whether the quality of the relationship between patients and their CBT therapist affects how much CBT helps reduce fatigue in ME/CFS. Researchers followed 217 patients through CBT treatment and measured both the therapeutic relationship (like whether patients felt heard and had confidence in treatment) and changes in fatigue-related thoughts and behaviors. They found that when patients started therapy with positive expectations and felt they understood what the therapy aimed to do, they experienced better improvements in fatigue by the end of treatment.

Interventions
E2 ModeratePEM requiredPreliminaryObservationalEditor reviewed

Benefit from B-Lymphocyte Depletion Using the Anti-CD20 Antibody Rituximab in Chronic Fatigue Syndrome

Øystein Fluge, Olav Mella, Ove Bruland et al.·PLoS ONE·2011·n=30

In this pilot RCT, 30 ME/CFS patients received rituximab (a B-cell depleting antibody used in cancer and autoimmune disease) or placebo. Two-thirds of the rituximab group showed clinical improvement, with delayed response patterns consistent with autoimmune disease mechanisms. The placebo group had minimal response.

InterventionsImmune System
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Therapist effects in routine psychotherapy practice: an account from chronic fatigue syndrome.

Cella, Matteo, Stahl, Daniel, Reme, Silje Endresen et al.·Psychotherapy research : journal of the Society for Psychotherapy Research·2011

This study looked at whether it matters which therapist treats patients with ME/CFS when they receive cognitive behavioral therapy (CBT). Researchers tracked 374 ME/CFS patients treated by 12 different therapists in a specialized clinic and measured changes in fatigue and disability. They found that while patients improved overall, the individual therapist made almost no difference in outcomes—the patients' improvements were similar regardless of which qualified therapist treated them.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

Does the heterogeneity of chronic fatigue syndrome moderate the response to cognitive behaviour therapy? An exploratory study.

Cella, Matteo, Chalder, Trudie, White, Peter D·Psychotherapy and psychosomatics·2011

This study looked at whether ME/CFS patients are different from each other in ways that predict how well they respond to cognitive behaviour therapy (CBT), a type of talking therapy. Researchers analyzed data from 236 patients and found that most patients improved with CBT regardless of their characteristics, but they identified a smaller group with certain traits—including weight changes, tremors, anxiety, and pain—who were less likely to benefit. The findings suggest CBT can help most people with ME/CFS, though a minority may need different approaches.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Cognitive behavioural treatment for chronic fatigue syndrome in a rehabilitation setting: effectiveness and predictors of outcome.

Schreurs, K M G, Veehof, M M, Passade, L et al.·Behaviour research and therapy·2011

This study tested whether combining cognitive behavioural therapy (a type of talking therapy that addresses thought patterns and behaviours) with graded exercise therapy (gradually increasing physical activity) helps people with ME/CFS. About one-third of patients experienced meaningful improvement in fatigue and physical function. The study found that patients who were more physically active before treatment, felt more in control of their symptoms, and had been unwell for a shorter time tended to do better.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Does hypocortisolism predict a poor response to cognitive behavioural therapy in chronic fatigue syndrome?

Roberts, A D L, Charler, M-L, Papadopoulos, A et al.·Psychological medicine·2010

This study looked at whether a hormone called cortisol, which helps regulate stress and energy, affects how well cognitive behavioural therapy (CBT) works for ME/CFS patients. The researchers measured cortisol levels in 84 ME/CFS patients and tracked how many improved after receiving CBT. They found that patients with lower cortisol levels were less likely to respond well to CBT, suggesting that abnormal cortisol may be one reason why ME/CFS persists in some people.

Interventions
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome.

Kempke, Stefan, Goossens, Lutgarde, Luyten, Patrick et al.·Journal of affective disorders·2010

This study followed 178 ME/CFS patients through a multi-component treatment program to identify which patient characteristics predicted who would improve. The researchers found that only depression severity before treatment started was associated with how fatigued patients remained after treatment—patients with higher depression were more likely to stay fatigued afterward. This suggests that addressing depression alongside other ME/CFS treatments may be important.

Interventions
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Use of medications by people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia.

Boneva, Roumiana S, Lin, Jin-Mann S, Maloney, Elizabeth M et al.·Health and quality of life outcomes·2009

This study looked at what medications and supplements people with ME/CFS were taking compared to healthy people and those with other chronic illnesses. Researchers found that over 90% of people with ME/CFS used at least one medication or supplement, and they used significantly more drugs overall—an average of 5.8 compared to 3.7 in healthy people. People with ME/CFS were more likely to take antidepressants, sleep aids, muscle relaxants, and pain relievers.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

Implementing cognitive behavior therapy for chronic fatigue syndrome in mental health care: a costs and outcomes analysis.

Scheeres, Korine, Wensing, Michel, Bleijenberg, Gijs et al.·BMC health services research·2008

This study tested whether cognitive behavior therapy (CBT), a talk-based treatment, could be successfully offered to ME/CFS patients at a mental health center and whether it was worth the cost. Researchers tracked 125 patients before and after treatment and found that 37% recovered from CFS, patients' healthcare costs went down, and overall costs to society were lower. The study suggests that offering CBT for ME/CFS in mental health settings could be both helpful and financially reasonable.

Interventions
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States.

Jones, James F, Maloney, Elizabeth M, Boneva, Roumiana S et al.·BMC complementary and alternative medicine·2007

This study looked at how many people with ME/CFS and similar fatiguing illnesses use complementary and alternative medicine (CAM) therapies like massage, chiropractic care, prayer, and other non-conventional treatments. Researchers surveyed over 880 people across the United States and found that people with ME/CFS-like illness were more likely to use body-based therapies (like massage and chiropractic) and mind-body therapies than people without fatigue.

Interventions
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

How relevant are exercise capacity measures for evaluating treatment effects in chronic fatigue syndrome? Results from a prospective, multidisciplinary outcome study.

Pardaens, K, Haagdorens, L, Van Wambeke, P et al.·Clinical rehabilitation·2006

This study tested whether a 6-month rehabilitation program combining cognitive therapy and graded exercise improved ME/CFS patients' quality of life and physical fitness. Patients reported significant improvements in how they felt and functioned in daily life, but their measured physical capacity (like strength and endurance on a bike test) only improved modestly. Importantly, feeling better didn't require becoming noticeably fitter—especially for patients who started out less fit.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

Prospective observational study of treatments for unexplained chronic fatigue.

Bentler, Suzanne E, Hartz, Arthur J, Kuhn, Evelyn M·The Journal of clinical psychiatry·2005

This study followed 155 people with chronic fatigue over 2 years to see which treatments they found helpful. Researchers asked participants about medications, supplements, exercise, yoga, and support groups they tried. While some treatments like yoga and vitamins were associated with feeling better, other treatments like magnesium and support groups were linked to feeling worse—though it's unclear why.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

[Clinical observation on effect of electro-acupuncture on back-shu points in treating chronic fatigue syndrome].

Wang, Qian, Xiong, Jia-xuan·Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine·2005

This study tested whether a type of acupuncture called electro-acupuncture (using small electrical currents with acupuncture needles) could help people with chronic fatigue syndrome (ME/CFS) feel less tired and have fewer symptoms. Forty patients received treatment targeting specific acupuncture points on the back, and researchers measured their fatigue and symptom levels before and after treatment. The results showed that fatigue and symptoms improved significantly after the treatment.

Interventions
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Chronic fatigue syndrome in children: a cross sectional survey.

Patel, M X, Smith, D G, Chalder, T et al.·Archives of disease in childhood·2003

This study looked at 36 children with ME/CFS who were seen at a specialist clinic in England. Most children improved significantly or returned to normal health, and those who received treatment attended school more often. However, about one-third of children left school without any qualifications, showing that ME/CFS can seriously disrupt education even when health improves.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

The use of a symptom "self-report" inventory to evaluate the acceptability and efficacy of a walking program for patients suffering with chronic fatigue syndrome.

Coutts, R, Weatherby, R, Davie, A·Journal of psychosomatic research·2001

This study tested whether a walking program could help people with ME/CFS feel better. Twenty patients with ME/CFS walked for 12 weeks at a pace matched to their fitness level. The researchers found that patients reported improvements in psychological stress and some other symptoms, and importantly, the walking did not make their ME/CFS symptoms worse.

Interventions
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Chronic fatigue syndrome: a follow up study.

Bonner, D, Ron, M, Chalder, T et al.·Journal of neurology, neurosurgery, and psychiatry·1994

Researchers followed up with 46 ME/CFS patients four years after their initial diagnosis to see how they were doing. Patients who had improved with treatment generally stayed better, while those who didn't benefit from treatment were unlikely to recover on their own. Patients who still had ME/CFS symptoms four years later tended to have had more physical health problems, greater fatigue levels, and a history of mental health conditions when first diagnosed.

Interventions
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Longitudinal Progression of Patients with Long COVID Treated in a Post-COVID Clinic: A Cross-Sectional Survey.

Hurt, Ryan T, Yadav, Siddhant, Schroeder, Darrell R et al.·Journal of primary care & community health·2024

This study surveyed over 500 Long COVID patients who received care at a specialized clinic about 2 years after their initial infection. While most patients reported that their symptoms improved compared to their first visit, only 4.5% felt they had fully recovered. Some treatments like low-dose naltrexone, vagal nerve stimulation, and fisetin were rated as helpful by a majority of patients who tried them.

Interventions
E2 ModeratePEM unclearModerate confidenceLongitudinalEditor reviewed

The relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome.

Ghali, Alaa, Lacombe, Valentin, Ravaiau, Camille et al.·Journal of translational medicine·2023

This study looked at whether pacing—a strategy where patients carefully manage their activity levels to avoid overexertion—helps people recover from long COVID. Researchers followed 86 patients for about 10 months and found that about one-third returned to work and another quarter improved significantly. Patients who stuck with pacing strategies most consistently had the best outcomes, with 60% recovering compared to only 5.5% of those who didn't follow pacing closely.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

Treatment of 741 Italian patients with chronic fatigue syndrome.

Tirelli, U, Lleshi, A, Berretta, M et al.·European review for medical and pharmacological sciences·2013

This study looked at 741 ME/CFS patients treated at an Italian hospital between 2000 and 2005 to see which treatments helped the most. Antiviral and immunoglobulin drugs (which boost the immune system) showed the best results, with about 15% of patients improving. The study also found that patients who received 4 or more different treatments had better outcomes than those who received fewer treatments.

Interventions
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Use and Perceived Helpfulness of Different Intervention Strategies in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Depression.

Dorczok, Marie Celine, Mossaheb, Nilufar, Mittmann, Gloria et al.·Journal of clinical medicine·2026

This study compared how people with ME/CFS and depression use different treatments and how helpful they find them. People with ME/CFS tried a much wider variety of interventions—especially pacing strategies and supplements aimed at energy—and found many of them helpful. In contrast, people with depression mainly used psychotherapy and antidepressants, which align with standard medical guidelines. The difference likely reflects that ME/CFS currently lacks established treatment guidelines, while depression has well-tested approaches.

Interventions
E2 ModeratePEM not requiredPreliminaryRegistry-ResourceEditor reviewed

Robuvit® reduces fatigue after chemotherapy for colon cancer. A pilot registry study.

Belcaro, Gianni, Cox, David, Cesarone, Maria R et al.·Minerva surgery·2023

This study tested whether Robuvit®, an oak wood extract supplement, could help reduce fatigue in people recovering from chemotherapy for colon cancer. Over six weeks, patients taking Robuvit® showed greater improvements in tiredness, strength, fitness, and mood compared to those receiving standard care alone, with no reported side effects.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

General theory of inflammation: patient self-administration of hydrocortisone safely achieves superior control of hydrocortisone-responding disorders by matching dosage with symptom intensity.

Irwin, John B, Baldwin, A L, Stenberg, Virgil I·Journal of inflammation research·2019

This study tested whether people with various chronic inflammatory conditions, including ME/CFS, could safely manage their own low-dose hydrocortisone treatment by adjusting it based on symptom flares. Over 2,000 participants achieved an average 76% improvement in symptoms while taking about 12 mg of hydrocortisone daily, and no serious side effects were reported.

Interventions
E2 ModeratePEM unclearModerate confidenceLongitudinalEditor reviewed

Adolescent chronic fatigue syndrome and somatoform disorders: a prospective clinical study.

Klineberg, Emily, Rushworth, Alexandra, Bibby, Helen et al.·Journal of paediatrics and child health·2014

This study followed 50 teenagers with chronic fatigue syndrome (CFS) or similar conditions for one year while they received treatment from a team of different specialists. Both groups of teens improved in their physical abilities and emotional well-being over the first 4 months, and these improvements lasted through 12 months. Teenagers with CFS had more persistent physical limitations than those with other similar conditions, especially if their illness started after a physical trigger like an infection.

Interventions
E2 ModeratePEM not requiredPreliminaryEditor reviewed

Characteristics of the formation of chronic fatigue syndrome and approaches to its treatment in young patients with focal brain damage.

Boiko, A N, Batysheva, T T, Matvievskaya, O V et al.·Neuroscience and behavioral physiology·2007

This study looked at why people with brain injuries (from multiple sclerosis, stroke, infection, or trauma) develop severe fatigue. Researchers tested 50 patients and gave half of them a medication called Fezam to see if it would help. The medication reduced fatigue symptoms, especially in MS patients, with few side effects.

Interventions
E3 PreliminaryPEM unclearPreliminaryObservationalEditor reviewed

Patient perspectives of recovery from myalgic encephalomyelitis/chronic fatigue syndrome: An interpretive description study.

Hasan, Zara, Kuyvenhoven, Cassandra, Chowdhury, Mehreen et al.·Journal of evaluation in clinical practice·2024

This study interviewed 33 ME/CFS patients who reported getting better, including 7 who recovered completely and 26 who improved significantly. Most patients had to figure out their own treatments without much help from doctors, often because they felt dismissed or stigmatized by healthcare providers. Patients who fully recovered most often credited mind-body approaches like meditation or cognitive therapy for their improvement.

Interventions
E3 PreliminaryPEM unclearPreliminaryEditor reviewed

Is the efficacy of repetitive transcranial magnetic stimulation influenced by baseline severity of fatigue symptom in patients with myalgic encephalomyelitis.

Yang, De Gang, Gu, Rui, Kubo, Jin et al.·The International journal of neuroscience·2020

Researchers tested whether a brain stimulation treatment called repetitive transcranial magnetic stimulation (rTMS) could help ME/CFS patients with fatigue. They treated 22 patients with 6-8 sessions of rTMS and measured fatigue levels before and after treatment. The study found that rTMS improved fatigue symptoms in all patients, whether they started with severe or mild fatigue.

Interventions
E3 PreliminaryPEM unclearPreliminaryMethods-PaperEditor reviewed

Approaching recovery from myalgic encephalomyelitis and chronic fatigue syndrome: Challenges to consider in research and practice.

Devendorf, Andrew R, Jackson, Carly T, Sunnquist, Madison et al.·Journal of health psychology·2019

This study interviewed 13 doctors who treat ME/CFS to understand the challenges they face when trying to measure whether patients are getting better. The researchers found four main areas that make recovery difficult to assess: differences in how the illness affects people at different ages, the fact that ME/CFS shows up differently in different patients, trouble keeping track of patients over time, and practical difficulties in measuring improvement.

InterventionsDiagnostics
E3 PreliminaryPEM unclearPreliminaryObservationalEditor reviewed

Treating patients suffering from myalgic encephalopathy/chronic fatigue syndrome (ME/CFS) with sodium dichloroacetate: An open-label, proof-of-principle pilot trial.

Comhaire, Frank·Medical hypotheses·2018

Researchers gave 22 ME/CFS patients a supplement containing sodium dichloroacetate to see if it might help their symptoms. About half of the patients (10 out of 22) felt significantly better and their fatigue scores dropped to roughly half of what they were before. The other half of the patients didn't improve, and doctors found that many of them had other underlying health conditions. This small study suggests that for some ME/CFS patients, a problem with how their cells produce energy might be treatable with this supplement.

Interventions
E3 PreliminaryPEM not requiredPreliminaryCross-SectionalEditor reviewed

'It feels sometimes like my house has burnt down, but I can see the sky': A qualitative study exploring patients' views of cognitive behavioural therapy for chronic fatigue syndrome.

Picariello, Federica, Ali, Sheila, Foubister, Caroline et al.·British journal of health psychology·2017

This study looked at what 13 ME/CFS patients thought about cognitive behavioural therapy (CBT), a talking therapy that helps people change unhelpful thinking patterns and behaviors. Most patients were satisfied with CBT and felt better, though not completely recovered. The study found that the personal support from a therapist and accepting that ME/CFS involves both physical and mental factors were important for success.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainReview-NarrativeEditor reviewed

FITNET's Internet-Based Cognitive Behavioural Therapy Is Ineffective and May Impede Natural Recovery in Adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. A Review.

Ghatineh, Simin, Vink, Mark·Behavioral sciences (Basel, Switzerland)·2017

This review examined a Dutch study called FITNET that claimed internet-based cognitive behavior therapy helped adolescents with ME/CFS recover at high rates. The reviewers found serious problems with how the study was designed and analyzed, including how they defined 'recovery' and that they didn't use objective measurements like activity monitors to confirm their results. The study actually found no meaningful difference between the therapy group and the usual care group at long-term follow-up, suggesting the treatment may not have worked as claimed.

Interventions
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

A Novel Approach to Treating CFS and Co-morbid Health Anxiety: A Case Study.

Daniels, Jo, Loades, Maria E·Clinical psychology & psychotherapy·2017

This study looked at treating ME/CFS in one patient who also had anxiety about their health. Instead of using standard treatments alone, doctors used a customized approach combining techniques for both the physical fatigue and the worry about health. After 8 sessions, the patient's symptoms improved significantly and stayed better a year later, suggesting this combined approach might help others with ME/CFS.

Interventions
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Same, Same But Different? Cognitive Behavioural Treatment Approaches for Paediatric CFS/ME and Depression.

Loades, M E, Chalder, T·Behavioural and cognitive psychotherapy·2017

Many young people with ME/CFS also experience depression, and both conditions can be treated with a talking therapy called cognitive behavioural therapy (CBT). This paper compares how CBT is used for these two conditions in children and teenagers, explaining that while the approaches share some similarities, they focus on different problems and use different strategies to help each condition.

Interventions
E3 PreliminaryPEM unclearPreliminaryEditor reviewed

Caring for people with severe myalgic encephalomyelitis: An interpretative phenomenological analysis of parents' experiences.

Mihelicova, Martina, Siegel, Zachary, Evans, Meredyth et al.·Journal of health psychology·2016

This study listened to parents who care for severely ill ME/CFS patients and asked about their experiences. Researchers found that parents often feel their identity has changed, experience guilt, feel isolated from others, deal with uncertainty about the future, and develop ways to cope with the demands of caregiving. The study provides important insights that could help healthcare providers better support and understand these caregivers.

Interventions
E3 PreliminaryPEM unclearPreliminaryMethods-PaperEditor reviewed

The use of mixed methods in studying a chronic illness.

Jason, Leonard A, Reed, Jordan·Health psychology and behavioral medicine·2015

This study explains how researchers can better understand ME/CFS by combining two research approaches: collecting personal stories and experiences from patients (qualitative methods) alongside measuring data with numbers and statistics (quantitative methods). When researchers used both methods together, they gained a fuller picture of ME/CFS—including how the disease spreads, what people think about the illness name, and which treatments work—than they would have using just one approach alone.

Interventions
E3 PreliminaryPEM not requiredModerate confidenceCross-SectionalEditor reviewed

Adolescents and mothers value referral to a specialist service for chronic fatigue syndrome or myalgic encephalopathy (CFS/ME).

Beasant, Lucy, Mills, Nicola, Crawley, Esther·Primary health care research & development·2014

This study asked 13 mothers and 12 teenagers with ME/CFS about their experiences getting help from a specialist ME/CFS service. Most families found it difficult and took a long time to access the specialist clinic, but once they got there, both teenagers and mothers felt it was valuable. The specialist service helped confirm the diagnosis, improved symptom management, and helped communication between doctors and schools.

InterventionsDiagnostics
E3 PreliminaryPEM not requiredPreliminaryEditor reviewed

Complete eradication of chronic long standing eczema and keratosis pilaris following treatment with dextroamphetamine sulfate.

Check, J H, Chan, S·Clinical and experimental obstetrics & gynecology·2014

This study describes two patients with ME/CFS who also had long-standing skin conditions (eczema and keratosis pilaris) that improved significantly when treated with dextroamphetamine, a stimulant medication. The authors suggest these skin problems may be related to an underactive nervous system that is also involved in ME/CFS, and that stimulant treatment may help both conditions.

Interventions
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Clinical observation on the effects of Bo's abdominal acupuncture in 40 cases of chronic fatigue syndrome.

Huang, Yong, Liao, Xiao-ming, Li, Xiao-xi et al.·Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan·2008

This study looked at whether a traditional Chinese acupuncture technique called Bo's abdominal acupuncture could help 40 people with chronic fatigue syndrome. Patients received acupuncture treatments once daily for 2 weeks, and researchers measured their symptoms and fatigue levels before and after treatment. The results showed that patients reported improvements in fatigue, loss of appetite, sleep problems, memory issues, diarrhea, and general pain.

Interventions
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Self within a climate of contention: Experiences of chronic fatigue syndrome.

Travers, Michele Kerry, Lawler, Jocalyn·Social science & medicine (1982)·2008

This study explored how people with ME/CFS experience their illness and how they cope with it, based on interviews with 19 Australian adults (including 3 who recovered). Researchers found that people with ME/CFS often feel their sense of self is damaged by the illness, and they use two main strategies to manage this: protecting themselves (the Guardian Response) and rebuilding their lives with new meaning (the Reconstructing Response). The study shows that living with ME/CFS involves an ongoing struggle as people balance these coping strategies depending on how severe their symptoms are at any given time.

Interventions
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

Successful use of a primary care practice-specialty collaboration in the care of an adolescent with chronic fatigue syndrome.

Kuo, Dennis Z, Cheng, Tina L, Rowe, Peter C·Pediatrics·2007

This case report describes how one teenager with ME/CFS improved significantly when their regular doctor and a specialized ME/CFS expert worked together as a team, even though they lived in different cities. By staying in regular contact through phone calls and emails and clearly dividing responsibilities, the two doctors were able to manage the teen's symptoms more effectively. The study suggests that this type of teamwork between primary care doctors and specialists can help young people with ME/CFS get better care.

Interventions
E3 PreliminaryPEM not requiredPreliminaryMethods-PaperEditor reviewed

The thoughts and methods for clinical research on acupuncture treatment of chronic fatigue syndrome.

Yao, Renmin·Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan·2007

This paper presents acupuncture treatment guidelines for chronic fatigue syndrome (ME/CFS), focusing on how acupuncture might restore balance to the body's energy systems according to traditional Chinese medicine. The authors discuss important considerations like which patients are most suitable for treatment, which acupuncture points to use, and how to measure whether the treatment is working.

Interventions
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

The debate: myalgic encephalomyelitis and chronic fatigue syndrome.

Shepherd, Charles·British journal of nursing (Mark Allen Publishing)·2006

This article discusses the ongoing disagreement among doctors and researchers about ME/CFS, including what causes it and how to treat it. The author explains that while we still don't fully understand what causes the illness, we are learning more about the factors that may trigger or worsen it. Good news: doctors now have treatments available that can help reduce symptoms and improve quality of life for patients, rather than simply accepting the illness as untreatable.

Interventions
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

[On the important role of Siguan points in treatment of chronic fatigue syndrome].

Wang, Jing-jing, Meng, Hong, Cui, Cheng-bin et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2006

This study examined whether a traditional Chinese medicine acupuncture technique called Siguan points might help treat chronic fatigue syndrome (ME/CFS). The researchers reviewed existing literature on this acupuncture method and concluded that using Siguan points as the main treatment approach showed promise for improving ME/CFS symptoms.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainEditorialEditor reviewed

Supporting people with severe myalgic encephalomyelitis.

Crowhurst, Greg·Nursing standard (Royal College of Nursing (Great Britain) : 1987)·2005

This article helps nurses better understand ME/CFS, a serious condition that is often misunderstood by healthcare providers. The author describes the main symptoms people experience and discusses how healthcare services can support patients. The article emphasizes that ME/CFS is a real physical illness that needs more research to help doctors and nurses care for people with it properly.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainReview-NarrativeEditor reviewed

An overview of chronic fatigue syndrome.

Jackson, Elizabeth·Nursing standard (Royal College of Nursing (Great Britain) : 1987)·2003

This article reviews what we know about ME/CFS, including the symptoms people commonly experience and how they can be treated. The author describes a new model of patient care that was tested in the community, which combines several different therapeutic approaches to help manage the condition.

Interventions
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

The effect of granisetron, a 5-HT3 receptor antagonist, in the treatment of chronic fatigue syndrome patients--a pilot study.

The, G K H, Prins, J, Bleijenberg, G et al.·The Netherlands journal of medicine·2003

Researchers tested whether a medication called granisetron, which affects a brain chemical involved in nausea and other functions, might help ME/CFS patients feel less fatigued. Five women with ME/CFS took the medication for one month and reported significant improvements in how tired they felt and how much they could do. However, this was a very small study without a comparison group, so much more research is needed to confirm these results.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainReview-NarrativeEditor reviewed

The symptoms and management of myalgic encephalomyelitis.

Richardson, Amanda·Nursing times·2002

ME/CFS is a long-lasting illness that affects people differently, and doctors still don't fully understand what causes it or how to cure it. However, there are helpful ways to manage the symptoms, and the best treatment plans are created together with each individual patient. While no medicine has been specifically designed for ME/CFS, doctors can adapt treatments used for similar symptoms in other conditions to help reduce suffering.

Interventions
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Treatment of chronic fatigue syndrome with 5-HT3 receptor antagonists--preliminary results.

Späth, M, Welzel, D, Färber, L·Scandinavian journal of rheumatology. Supplement·2000

Researchers tested whether two medications that block serotonin receptors (tropisetron and ondansetron) might help ME/CFS patients feel less fatigued. About one third of the patients who took these medications reported meaningful improvement in fatigue and energy levels over 15 days, with no serious side effects reported.

Interventions
E3 PreliminaryPEM not requiredPreliminaryEditor reviewed

Fatigue that doesn't go away.

Propsner, N M·New Jersey medicine : the journal of the Medical Society of New Jersey·1999

This article describes chronic fatigue syndrome (ME/CFS), a condition where people experience extreme tiredness that doesn't improve with rest. The fatigue often begins after a viral infection and is more commonly seen in middle-aged women. While current treatments can help manage symptoms, researchers are working to better understand the condition and develop more effective approaches.

Interventions
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

Chronic fatigue syndrome: an update for clinicians in primary care.

Houde, S C, Kampfe-Leacher, R·The Nurse practitioner·1997

This article explains what ME/CFS is and how doctors can recognize it. The main challenge is that ME/CFS doesn't show up on standard tests, so doctors need to rule out other conditions first. Treatment works best when it's tailored to each person's specific symptoms and needs.

InterventionsDiagnostics
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

N of 1 trials. Managing patients with chronic fatigue syndrome: two case reports.

Wiebe, E·Canadian family physician Medecin de famille canadien·1996

This study looked at two individual ME/CFS patients to see which treatments might help them personally. One patient tried high-dose vitamin B12 injections but they didn't help. Another patient tried a medication called nimodipine and found it worked very well for them. The doctors used a special testing method called N of 1 trials, where treatments are tested in one person at a time to see what actually helps that specific individual.

Interventions
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

[Chronic fatigue syndrome].

Rouillon, F, Delhommeau, L, Vinceneux, P·Presse medicale (Paris, France : 1983)·1996

This review examines chronic fatigue syndrome (CFS), a condition where people experience lasting, unexplained tiredness that interferes with daily life. The condition has been recognized for over a century under different names. Currently, doctors and researchers don't fully understand what causes CFS, though it may involve viral infections, immune system problems, or psychiatric factors. Most treatments tested so far have shown limited effectiveness.

Interventions
E3 PreliminaryPEM unclearPreliminaryGuidelineEditor reviewed

[Therapeutic guidelines in chronic fatigue syndrome].

Bertolín Guillén, J M, Bedate Villar, J·Actas luso-espanolas de neurologia, psiquiatria y ciencias afines·1994

This article reviews different treatment approaches for ME/CFS, which currently lacks a definitive cure. Researchers found that antidepressant medications—particularly amfebutamone and selective serotonin reuptake inhibitors—showed the most promise, while other medications (antivirals, immune boosters, anti-inflammatory drugs) had limited success. A combination of cognitive behavioral therapy and comprehensive psychiatric management tailored to each patient's needs also appeared helpful.

Interventions
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Amma therapy: a holistic approach to chronic fatigue syndrome.

Young, A·Journal of holistic nursing : official journal of the American Holistic Nurses' Association·1993

This study looked at Amma Therapy, a hands-on healing practice, as a possible way to help people with ME/CFS who feel frustrated with traditional medical care. The researcher examined how this holistic approach might benefit patients with chronic fatigue. The study suggests that some people with ME/CFS may find relief through this alternative therapy.

Interventions
E3 PreliminaryPEM not requiredWeak / uncertainObservationalEditor reviewed

Chronic Fatigue Syndrome: Do herbs or homeopathy help?

Leyton, E, Pross, H·Canadian family physician Medecin de famille canadien·1992

This study tested whether herbal and homeopathic treatments could help six ME/CFS patients feel better. Researchers tracked symptoms and measured blood markers before and after treatment. The treatments did not produce any measurable improvements in symptoms or immune function.

Interventions
E3 PreliminaryPEM not requiredWeak / uncertainCase-ControlEditor reviewed

Chronic fatigue syndrome.

Gerow, G, Poierier, M B, Alt, R·Journal of manipulative and physiological therapeutics·1992

This study describes a 36-year-old woman who came to her doctor with severe fatigue and symptoms that looked like an immune system problem, but was eventually diagnosed with ME/CFS instead. The doctors used specific criteria to confirm the diagnosis. The patient reported feeling somewhat better after receiving chiropractic treatment, though this was only one person's experience.

Interventions
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

Chronic fatigue syndrome. Recent advances in diagnosis and treatment.

Bell, D S·Postgraduate medicine·1992

ME/CFS typically starts suddenly with severe tiredness and flu-like symptoms that come and go over months or years. While blood tests sometimes show immune system changes, doctors diagnose ME/CFS mainly by recognizing the pattern of symptoms and ruling out other illnesses. Current treatment focuses on managing symptoms and helping patients cope with this long-lasting, disabling condition.

InterventionsDiagnostics
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Bupropion treatment of fluoxetine-resistant chronic fatigue syndrome.

Goodnick, P J, Sandoval, R, Brickman, A et al.·Biological psychiatry·1992

This study tested whether bupropion, an antidepressant medication, could help ME/CFS patients who didn't benefit from or couldn't tolerate fluoxetine (another antidepressant). Nine patients took 300 mg of bupropion daily for 8 weeks and showed significant improvement in depression symptoms. The researchers also found that bupropion appeared to affect certain brain chemicals and immune markers in ways that correlated with symptom improvement.

Interventions
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Cognitive behaviour therapy in chronic fatigue syndrome.

Butler, S, Chalder, T, Ron, M et al.·Journal of neurology, neurosurgery, and psychiatry·1991

This study tested whether cognitive behaviour therapy (CBT)—a type of talk therapy focusing on thoughts and behaviors—could help 50 ME/CFS patients who had been sick for an average of five years. Patients received therapy aimed at identifying unhelpful beliefs about their symptoms and gradually returning to activities. The therapy led to meaningful improvements in fatigue, overall functioning, and mood, though some patients refused treatment.

Interventions
E3 PreliminaryPEM unclearPreliminaryCase-ControlEditor reviewed

The novel application of the Lightning Process to treat Long COVID in primary care - Case report.

Finch, F, Parker, P, Nollett, C et al.·Explore (New York, N.Y.)·2024

This study looked at whether a self-help program called the Lightning Process could help two Long COVID patients manage their fatigue and other symptoms. Both patients reported feeling better in terms of tiredness, physical symptoms, and emotional wellbeing after completing the program and three months later. While these results are encouraging, this is a very small report of just two people, so we need larger studies to know if this approach works for most Long COVID patients.

Interventions
E3 PreliminaryPEM unclearPreliminaryEditor reviewed

Corona With Lyme: A Long COVID Case Study.

Thor, Danielle C, Suarez, Sergio·Cureus·2023

This study follows one 26-year-old medical student over three years as she developed and recovered from long COVID symptoms after an acute COVID-19 infection. The case documents her journey through various treatments and how her symptoms gradually improved over time. While this is just one person's experience, it provides insight into how long COVID can develop and potentially resolve.

Interventions
E3 PreliminaryPEM unclearPreliminaryCase-ControlEditor reviewed

An Exercise Prescription as a Novel Management Strategy for Treatment of Long COVID.

Rudofker, Eric W, Parker, Hugh, Cornwell, William K·JACC. Case reports·2022

This study describes a small group of long COVID patients whose symptoms improved or went away when they exercised regularly. The researchers suggest that exercise might be a helpful treatment strategy for long COVID, since the condition may partly involve the heart and muscles becoming deconditioned (weak from lack of use).

Interventions
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Can l-carnitine reduce post-COVID-19 fatigue?

Vaziri-Harami, Roya, Delkash, Parisa·Annals of medicine and surgery (2012)·2022

Some people develop long-lasting fatigue after COVID-19 infection, similar to ME/CFS, and this fatigue can last for months. This article suggests that L-carnitine, a natural substance that helps cells produce energy, might help reduce this type of fatigue based on its success in treating fatigue caused by other diseases like cancer and multiple sclerosis. The authors recommend testing L-carnitine in clinical trials to see if it actually works and is safe for people with post-COVID fatigue.

Interventions
E3 PreliminaryPEM not requiredPreliminaryCross-SectionalEditor reviewed

Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study.

Antcliff, Deborah, Keenan, Anne-Maree, Keeley, Philip et al.·BMJ open·2021

This study tested whether a new framework could help healthcare professionals teach patients with chronic pain and fatigue (including ME/CFS) how to pace their activities more effectively. Patients attended a 6-week rehabilitation program and were asked about their pain, fatigue, mood, and quality of life before the program, at the end, and 3 months later. Most patients felt satisfied with the program, and those who completed it showed improvements in their ability to pace themselves and manage their symptoms.

Interventions
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

Paroxysmal Kinesigenic Dyskinesia Symptoms Markedly Reduced with Parenteral Vitamins and Minerals: A Case Report.

Bruton, Alisha, Fuller, Leslie·The Permanente journal·2019

This report describes one woman who had both a rare movement disorder (paroxysmal kinesigenic dyskinesia) and chronic fatigue syndrome. When she received weekly injections of vitamins and minerals, her movement disorder symptoms almost completely went away, and she was able to return to her normal daily activities. Genetic testing found several mutations that may help explain why this treatment worked so well for her.

Interventions
E3 PreliminaryPEM unclearModerate confidenceMethods-PaperEditor reviewed

Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain and Fatigue.

Antcliff, Deborah, Campbell, Malcolm, Woby, Steve et al.·Physical therapy·2015

This study tested a questionnaire designed to measure how well people with chronic fatigue and pain pace their activities—meaning how they balance rest and activity throughout the day. Researchers simplified the original 38-question survey down to 26 questions and identified five different ways people try to pace themselves: adjusting activities, keeping activities consistent, gradually increasing activities, planning activities, and accepting limitations. The questionnaire was found to be reliable and useful for measuring pacing strategies.

Interventions
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions.

Friedlander, Justin I, Shorter, Barbara, Moldwin, Robert M·BJU international·2012

This review examined how food and beverages affect bladder pain syndrome (IC/BPS) and related conditions like fibromyalgia and chronic fatigue. Nearly 90% of patients report that certain foods make their symptoms worse—especially acidic foods like citrus and tomatoes, caffeine, alcohol, and spicy foods—while some substances like calcium and baking soda may help. The researchers recommend that patients work with their doctors to identify their personal food triggers through careful elimination diets rather than avoiding foods unnecessarily.

Interventions
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Atypical depression spectrum disorder - neurobiology and treatment.

Murck, Harald·Acta neuropsychiatrica·2003

This article explores a type of depression with unusual symptoms—like eating more and sleeping more instead of less—that is often overlooked in standard depression assessments. The author suggests this pattern of depression shares biological similarities with chronic fatigue syndrome, fibromyalgia, and other related conditions, and that all of these may involve a common problem with how the body regulates stress hormones. Different medications may work better for this type of depression than those typically used for other forms.

Interventions
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

Acupuncture in the treatment of post viral fatigue syndrome--a case report.

Mears, Tim·Acupuncture in medicine : journal of the British Medical Acupuncture Society·2005

This case report describes one patient with ME/CFS (chronic fatigue syndrome) who received electroacupuncture treatment. While the acupuncture did not cure the condition, the patient reported significant symptom improvement and was eventually able to return to work. This is one of the first published studies looking at how acupuncture might help ME/CFS patients.

Interventions
E3 PreliminaryPEM not requiredPreliminaryMethods-PaperEditor reviewed

Combining Topic Modeling, Sentiment Analysis, and Corpus Linguistics to Analyze Unstructured Web-Based Patient Experience Data: Case Study of Modafinil Experiences.

Walsh, Julia, Cave, Jonathan, Griffiths, Frances·Journal of medical Internet research·2024

Researchers analyzed nearly 70,000 posts from online forums and social media where people discussed their experiences taking modafinil, a wakefulness-promoting medication. They used computer programs to organize and understand what people wrote about how the drug affected them, what side effects they experienced, and whether it helped their symptoms. They found that most people reported positive experiences, but this contrasts sharply with what formal clinical trials have shown about modafinil's effectiveness.

Interventions
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

[Physical activity for mental health].

Martinsen, E W·Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke·2000

This review examined whether exercise can help treat mental health conditions like depression and anxiety. The research found that exercise works best for mild to moderate depression and chronic fatigue syndrome, and may also help with panic disorder, anxiety, and other conditions. Exercise appears to be a useful, affordable alternative or addition to standard treatments like medication and therapy.

Interventions
E0 ConsensusPEM unclearModerate confidenceSystematic-ReviewMachine-drafted

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

Dannaway, Jasan, New, Cameron C, New, Charles H et al.·British journal of sports medicine·2018

This review examined multiple studies to determine whether exercise therapy helps people with ME/CFS. The researchers looked at existing evidence to see if physical activity programs could improve fatigue and other symptoms. However, it's important to note that findings on exercise for ME/CFS are complex and sometimes controversial in the patient community.

Interventions
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeMachine-drafted

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

Smith, Simon N, Crawley, Esther·Archives of disease in childhood·2013

This review examined whether talking therapies and behavioral approaches can effectively treat ME/CFS in children. The researchers looked at existing studies to understand what treatments have been tested and how well they worked. This helps doctors and families understand what options might help children with ME/CFS manage their condition.

Interventions
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeMachine-drafted

Chronic fatigue syndrome.

Reid, Steven, Chalder, Trudie, Cleare, Anthony et al.·Clinical evidence·2003

This systematic review summarizes what is known about chronic fatigue syndrome (ME/CFS) by examining existing research. The authors looked at the best available evidence about how the condition develops, how it affects people, and what treatments might help. This type of review helps doctors and patients understand the current state of knowledge about ME/CFS.

Interventions
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeMachine-drafted

Chronic fatigue syndrome.

Reid, S, Chalder, T, Cleare, A et al.·BMJ (Clinical research ed.)·2000

This was a systematic review that brought together existing research about chronic fatigue syndrome (ME/CFS) to understand what was known at the time. The researchers looked at multiple studies to summarize the current evidence about the condition. This type of overview helps doctors and patients understand the state of knowledge about ME/CFS.

Interventions
E1 ReplicatedPEM unclearPreliminaryRCTMachine-drafted

Acupuncture and Chinese patent drugs for treatment of chronic fatigue syndrome.

Lijue, Zhao·Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan·2005

This study tested whether acupuncture and traditional Chinese herbal medicines could help people with chronic fatigue syndrome (ME/CFS). Researchers compared patients who received these treatments to a control group to see if they experienced improvements in their fatigue and symptoms.

Interventions
E2 ModeratePEM unclearModerate confidenceMachine-drafted

Group Cognitive Behaviour Therapy for Chronic Fatigue Syndrome.

Illegems, Jela, Moorkens, Greta, Van Den Eede, Filip·Psychotherapy and psychosomatics·2016

This study looked at whether group cognitive behaviour therapy (a type of talk therapy that helps people change unhelpful thinking patterns) could help people with ME/CFS. The researchers observed patients receiving this therapy together in groups. The study provides insights into how this type of psychological treatment is delivered and received by ME/CFS patients in a clinical setting.

Interventions
E2 ModeratePEM not requiredPreliminaryObservationalMachine-drafted

[The peculiarities of formation and approaches to the treatment of chronic fatigue syndrome in young patients with focal brain damage].

Boĭko, A N, Batysheva, T T, Matvievskaia, O V et al.·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2006

This study looked at chronic fatigue (tiredness that doesn't go away) in young patients who had brain injuries or diseases like multiple sclerosis or other brain conditions. Researchers tested whether a medication called Fezam (made from piracetam and cinnarizin) could help reduce this fatigue. The medication did help reduce fatigue severity, particularly in MS patients, though some patients experienced mild side effects like sleep problems.

Interventions
E3 PreliminaryPEM unclearPreliminaryCase-ControlMachine-drafted

A Continuous Oral Regimen of High-Dose Cromolyn Sodium Is Effective for Some Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Patients With Mast Cell Activation Syndrome.

Christoforou, Maritsa E, van Campen, Linda C, Visser, Frans C et al.·Cureus·2026

This study looked at five ME/CFS patients who also had mast cell activation syndrome (a condition where immune cells release too many chemicals). These patients took a medication called cromolyn sodium in higher doses than usual—up to 2400 mg per day instead of the standard 800 mg—by sipping it continuously throughout the day rather than taking four separate doses. All five patients reported improvements in their symptoms.

Interventions
E3 PreliminaryPEM unclearPreliminaryMachine-drafted

Successful treatment of myalgic encephalomyelitis/chronic fatigue syndrome using hydrogen gas: four case reports.

Hirano, Shin-Ichi, Ichikawa, Yusuke, Sato, Bunpei et al.·Medical gas research·2024

This study looked at four patients with ME/CFS who were treated with hydrogen gas and reported improvements in their symptoms. The researchers described how each patient used hydrogen gas therapy and what changes they noticed over time. While the results are encouraging for these individual cases, this is a very small study that needs much larger research to confirm whether hydrogen gas could help ME/CFS patients more broadly.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainMachine-drafted

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: How to Help Yourself.

American family physician·2023

This is a practical guide published in a family medicine journal to help ME/CFS patients manage their condition themselves. The article provides advice on self-care strategies and coping techniques that people with ME/CFS can use in their daily lives. Since there is no abstract available, the specific recommendations cannot be detailed, but the resource aims to give patients actionable steps they can take to improve their quality of life.

Interventions
E3 PreliminaryPEM unclearPreliminaryMachine-drafted

‘The Lightning Process’ and chronic fatigue syndrome/myalgic encephalomyelitis.

Vallings, Rosamund·Journal of primary health care·2022

This study examines 'The Lightning Process,' a coaching program that some people claim can help with ME/CFS. The author, a doctor experienced in ME/CFS care, analyzed what is known about this approach and its effects on patients with this illness. The study raises concerns about whether the program is safe and effective for people with ME/CFS.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainReview-NarrativeMachine-drafted

[Chronic fatigue syndrome and an approach to its treatment].

Akarachkova, E S·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2010

This is a review article discussing chronic fatigue syndrome (ME/CFS) and treatment approaches. The authors examine what is known about the condition and offer clinical guidance on how to manage it. While not a new research study, it provides a medical perspective on understanding and treating this complex illness.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainMachine-drafted

Ayurvedic treatment of chronic fatigue syndrome--a case report.

Vinjamury, Sivarama Prasad, Singh, Betsy B·Alternative therapies in health and medicine·2005

This case report describes one patient with chronic fatigue syndrome (ME/CFS) who received treatment using Ayurveda, a traditional medicine system from India. The authors documented whether Ayurvedic treatments helped reduce the patient's fatigue and other symptoms. While the patient showed some improvement, this is just one person's experience and cannot tell us whether this approach works for most people with ME/CFS.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainReview-NarrativeMachine-drafted

Chronic fatigue syndrome. Symptom relief is primary goal.

Hoffman, Diane B·Advance for nurse practitioners·2002

This article discusses chronic fatigue syndrome (ME/CFS) and emphasizes that helping patients feel better is the main goal of treatment. The author, writing for nurse practitioners, focuses on practical approaches to managing symptoms and improving patients' quality of life.

Interventions
E3 PreliminaryPEM unclearWeak / uncertainReview-NarrativeMachine-drafted

Chronic fatigue syndrome: current concepts of pathogenesis and treatment.

Lloyd, A R, Hickie, I, Peterson, P K·Current clinical topics in infectious diseases·1999

This review article examines what scientists understood in 1999 about how ME/CFS develops and what treatments might help. The authors synthesize existing knowledge about the condition's causes, which involve the immune system, infections, and other body system changes. They discuss various approaches to managing symptoms and improving function for people living with ME/CFS.

Interventions
E3 PreliminaryPEM unclearPreliminaryMachine-drafted

A 56-year-old woman with chronic fatigue syndrome, 1 year later.

Delbanco, T L, Daley, J, Hartman, E E·JAMA·1998

This study describes the medical journey of one woman with ME/CFS over the course of a year, documenting how her symptoms changed and how different treatments affected her condition. The researchers tracked her experiences to provide insight into what living with ME/CFS is like over time and what approaches doctors tried to help her.

Interventions
E3 PreliminaryPEM unclearPreliminaryMachine-drafted

Hypnosis in chronic fatigue syndrome.

Gregg, V H·Journal of the Royal Society of Medicine·1997

This study examined whether hypnosis might help people with ME/CFS. Researchers compared people with ME/CFS who received hypnosis treatment to those who did not. The study provides early information about whether this type of mind-body treatment might be beneficial for managing symptoms.

Interventions
E3 PreliminaryPEM unclearPreliminaryCase-ControlMachine-drafted

Nortriptyline in chronic fatigue syndrome: a double blind, placebo-controlled single case study.

Gracious, B, Wisner, K L·Biological psychiatry·1991

This study tested whether a medication called nortriptyline (an older type of antidepressant) could help one person with ME/CFS. The researchers gave the patient either the medication or a placebo (inactive pill) without telling them which was which, and tracked how they felt. This type of single-patient study can provide useful information, but it only shows what happened with one individual and cannot prove the treatment works for everyone with ME/CFS.

Interventions
E3 PreliminaryPEM unclearPreliminaryMachine-drafted

Effective treatment for an adolescent with chronic fatigue syndrome.

Wachsmuth, J R, MacMillan, H L·Clinical pediatrics·1991

This study describes the case of a teenager with chronic fatigue syndrome (ME/CFS) who received treatment. The doctors documented how the patient was evaluated and what approach was used to help manage their symptoms. This single case report provides an early clinical example of treating ME/CFS in young patients.

Interventions

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