295:
recovery differently. Recovery was operationally defined by reference to, either alone or in combination: fatigue or related symptoms; function; premorbid function; and/or brief global assessment (which was the most common outcome measure, but does not provide information on symptoms and function, and does not "provide assurance that patients have substantially recovered rather than simply improved"). Focusing on only fatigue or function may overestimate recovery rates, because patients may show selective rather than overall change. A patient with reduced self-reported fatigue may still experience functional disruptions, pain, sleep disturbances, or malaise. "Recovery" in the reviewed studies was often based on limited assessments, less than a full restoration of health, and self-reports with a general lack of more objective measures. In the absence of definitive measures, recovery criteria should set high but reasonable standards for behavioural recovery which approach restoration of pre-morbid health. When objective measures are used, such as the relatively objective behavioural measure of actigraphy, the results have been contrary to the cognitive behavioural model of CFS which predicts increased physical functioning as a result of intervention, as otherwise 'successful' trials did not find significant changes in physical activity. The authors state "a more modest interpretation of 'recovery' might characterize such outcomes as successful adaptation of illness-related behaviour and attitudes to ongoing but perhaps diminished illness", "improved or recovered patients may have continued to avoid activity levels that provoked debilitating
183:
increase their activity levels unless they feel able to do so. Patients are advised to set manageable daily activity/exercise goals and balance their activity and rest to avoid possible over-doing which may worsen their symptoms. A small randomised controlled trial concluded pacing with GET had statistically better results than relaxation/flexibility therapy. A 2008 patient survey by Action for ME found pacing to be the most helpful treatment and a 2009 survey of two
Norwegian patient organizations (ME-association and MENiN) had found that 96% evaluated pacing as useful. In 2019, a large UK found that pacing led to greater improvements in patients' physical health, although a minority did report becoming worse.
299:", which "would seem to be more consistent with a hypothesis of successful adaptation rather than recovery". It was concluded that more precise and accurate labels other than "recovery" (e.g. clinically significant improvement) may be more appropriate and informative for the improvements reported in previous research, and in keeping with commonly understood conceptions of recovery from illness, recommended a consistent definition of recovery that "captures a broad-based return to health with assessments of both fatigue and function as well as the patient's perceptions of his/her recovery status" and "the recovery time following physical and mental exertion".
196:) should reduce, allowing for "modest" gains in functioning as a result. Energy envelope theory is considered to be consistent with pacing, and is a management strategy suggested in the 2011 international consensus criteria for ME, which refers to using an "energy bank budget". Energy envelope theory was first described in 1999. Several studies have found energy envelope theory to be a helpful management strategy for CFS, noting that it reduces symptoms and may increase functioning. Energy envelope theory does not recommend unilaterally increasing or decreasing activity and is not intended as a therapy or cure for CFS.
3362:
1599:
591:
after treatment, and no significant differences in pre-treatment red-cell membrane lipids between the two groups. The different results may be explained by the patient selection: the first trial tested people with PVFS, whereas the second used the Oxford criteria for CFS. Also, the first trial used paraffin while the second trial used sunflower oil which is better tolerated and less likely to adversely affect the placebo group.
36:
128:
249:
participants who reported using CBT, 7% reported it to be helpful, 67% reported no change, and 26% reported that it made their condition worse. A large survey commissioned in the UK by NICE for the guidelines review found that CBT for CFS was not effective for more than half of people with CFS, and patients were more likely to get worse physically than to improve.
491:
randomized, placebo-controlled, double-blind, multicenter RituxME trial comparing multiple brands of rituximab infusions with placebo in 151 ME/CFS patients concluded that “B-cell depletion using several infusions of rituximab over 12 months was not associated with clinical improvement in patients with ME/CFS,” and thirty-four patients had serious events. “
241:
questionnaire scores. They conclude that the effect of CBT on fatigue questionnaire scores is not mediated by a change in physical activity. According to the authors of a 2014 systematic review, the lack of changes to objectively measured physical activity contradict the cognitive behavioural model of CFS and suggest that patients still avoided
1833:"Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy"
283:, so the effects on current patient cohorts may be different. An independent analysis of the same studies reached the opposite conclusion based on the unreliability of subjective outcomes in unblinded trials, lack of objective improvements in physical fitness and employment, and insufficient tracking of adverse events.
499:
There have been two RCTs with staphylococcal toxoid vaccine. A small RCT showed considerable benefit and a large follow-up RCT showed overall benefit. However the quality of the follow-up RCT was low and there were relatively high levels of adverse effects, although the increase in adverse effects in
228:
Cognitive behaviour therapy (CBT) can be used to help people cope with their illness, and by teaching individuals to better management of rest and activity within the boundaries of the energy constraints of the disorder, and does not actively attempt to improve the patient's physical or psychological
441:
During a randomized, double-blind trial conducted between 1992 and 1996, hydrocortisone treatment (at a higher dose of 20–30 mg) was associated with some statistical improvement in symptoms of ME/CFS. However, the authors concluded that the degree of adrenal suppression precludes its practical
294:
A 2014 systematic review reported that estimates of recovery from CFS ranged between 0 and 66% in intervention studies and from 2.6 to 62% in naturalistic studies. There was a lack of consensus in the literature on how recovery should be defined, with almost all of the 22 included studies measuring
219:
is a way of understanding activity management in chronic illness and is based on the idea that each patient has a limited number of "spoons", with each spoon representing their available energy. A healthy person has an unlimited amount of available energy each day, but a person with chronic illness
524:
A systematic review found five RCTs to have assessed the effects of immunoglobulin treatment for ME/CFS; of these, two RCTs showed an overall beneficial effect and two RCTs showed some positive results, although in one of the studies this was for physiological effects only. The largest of the RCTs
490:
and the CFS improved. As of 2017 this use had been explored in some small clinical trials and was undergoing some larger ones; it was unclear as of 2017 whether there is enough benefit in light of the known adverse effects, for rituximab to be a viable treatment for ME/CFS. Results from the 2-year
182:
Pacing (activity management) is a management strategy rather than a therapy. Pacing encourages behavioral change, but unlike cognitive behavioural therapy, acknowledge the typical patient fluctuations in symptom severity and experience delayed exercise recovery. Pacing does not require patients to
378:
The evidence for antidepressants is mixed and their use remains controversial. In a review of pharmacological treatments for ME/CFS, five trials of antidepressants were included but only one of these reported a statistically significant improvement in symptoms and this effect was only observed in
1154:
Carruthers BM, van de Sande MI, De
Meirleir KL, Klimas NG, Broderick G, Mitchell T, Staines D, Powles ACP, Speight N, Vallings R, Bateman L, Bell DS, Carlo-Stella N, Chia J, Darragh A, Gerken A, Jo D, Lewis D, Light AR, Light K, Marshall-Gradisnik S, McLaren-Howard J, Mena I, Miwa K, Murovska M,
622:
have been suggested as treatments for generalized fatigue since the 1950s, however recent studies do not suggest any benefit from it, either for generalized fatigue or CFS specifically. Further research is needed, however, as studies to date have been small and used inconsistent dosing regimens.
590:
containing n-6 GLA together with fishoil concentrate containing n-3 EPA and DHA showed significant overall improvement in symptoms and RBC essential fatty acid levels. However a subsequent RCT trying to replicate this study found no significant differences between the treatment and placebo group
573:
was reported. By the end of the treatment, significant differences between the two groups were found for both physical and mental fatigue and improvements in both the cognitive status and physical functions. A 2002 double‐blind randomized controlled trial with 53 patients found no difference in
1661:
The results are consistent across trials with improvement in function, fatigue, and global improvement and provided moderate strength of evidence for improved function (4 trials, n=607) and global improvement (3 trials, n=539), low strength of evidence for reduced fatigue (4 trials, n=607) and
248:
CBT has been criticised by patients' organisations because of negative reports from many of their members which have indicated that CBT can sometimes make people worse, a common result across multiple patient surveys. One such survey conducted by Action for ME in 2001 found that out of the 285
1978:
Bateman, Lucinda; Bested, Alison C.; Bonilla, Hector F.; Chheda, Bela V.; Chu, Lily; Curtin, Jennifer M.; Dempsey, Tania T.; Dimmock, Mary E.; Dowell, Theresa G.; Felsenstein, Donna; Kaufman, David L.; Klimas, Nancy G.; Komaroff, Anthony L.; Lapp, Charles W.; Levine, Susan M. (November 2021).
240:
A 2010 meta-analysis of trials that objectively measured physical activity before and after CBT showed that although CBT effectively reduced patients' fatigue questionnaire scores, activity levels were not improved by CBT and changes in physical activity were not related to changes in fatigue
437:
The evidence for corticosteroids is limited. A 2006 systematic review examined RCTs of steroids, primarily hydrocortisone, which found one with a significant difference between groups for fatigue, but two other RCTs found no benefit for steroid treatment. The study which showed statistical
603:
delivered by injection to magnesium-deficient CFS patients were published in 1991, but three subsequent studies did not find magnesium deficiency as a general problem in CFS patients. A 2008 review concluded that there is no good evidence that intramuscular magnesium is of benefit in CFS.
349:
Rintatolimod has achieved statistically significant improvements in primary endpoints in Phase II and Phase III double-blind, randomized, placebo-controlled clinical trials with a generally well tolerated safety profile and supported by open-label trials in the United States and Europe.
237:(CBT) based on this model attempts to reverse patients' symptoms by altering their interpretation of their symptoms and/or the behaviours they engage in as a result. In 2016, an ARHQ addendum downgraded the evidence for CBT and stated it should not be used as a primary treatment.
278:
review of 8 studies concluded that GET probably reduces fatigue but that evidence on long-term effectiveness and potential harms are very limited. Effects obtained with exercises were greater than pacing but similar to those obtained with CBT. The studies analyzed employed older
533:
In the absence of proven treatments, alternative medicine treatments are often tried in CFS. Some of these therapies are ineffective while others have not been studied enough to prove any effect. Many studies of alternative treatments for CFS suffer from a high risk of bias.
566:(fats) for the generation of metabolic energy including in muscles and in the brain. Two RCTs found benefit from dietary supplementation with L-carnitine or its esters. A 2006 systematic review reported one RCT with overall benefit, although there was no placebo control.
457:(POTS) to treat orthostatic intolerance. Given the high comorbidity rate between ME/CFS and POTS, it’s possible that fludrocortisone could reduce symptoms in these patients. However, there is no research available which examines its effect on comorbid ME/CFS and POTS.
1884:"A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS"
232:
CBT should not be offered as a cure. According to the cognitive-behavioural model of CFS, it is the patient's interpretation of symptoms that primarily shapes their behaviour and perpetuates the illness, and that changing these can lead to complete recovery.
3496:
Brouwers FM, Van Der Werf S, Bleijenberg G, Van Der Zee L, Van Der Meer JW (October 2002). "The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome: a double-blind randomized controlled trial".
3067:"Effect of Dietary Coenzyme Q10 Plus NADH Supplementation on Fatigue Perception and Health-Related Quality of Life in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial"
3581:
Warren G, McKendrick M, Peet M (February 1999). "The role of essential fatty acids in chronic fatigue syndrome. A case-controlled study of red-cell membrane essential fatty acids (EFA) and a placebo-controlled treatment study with high dose of EFA".
229:
capacity. This type of intervention does not assume the symptoms originate from maladaptive illness beliefs. The CDC currently suggests supportive counseling may be helpful in coping with the impact of the illness, but does not directly suggest CBT.
207:
Some patient groups recommend pacing using a heart rate monitor to increase awareness of exertion, and to allow patients to stay within their aerobic threshold envelope. Randomized controlled trials of pacing using a heart rate monitor are lacking.
713:
Smith ME, Haney E, McDonagh M, Pappas M, Daeges M, Wasson N, et al. (June 2015). "Treatment of
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop".
3130:
Fluge Ø, Rekeland IG, Lien K, Thürmer H, Borchgrevink PC, Schäfer C, et al. (May 2019). "B-Lymphocyte
Depletion in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial".
322:
Nucleic acid (double-stranded RNA) compounds represent a potential new class of pharmaceutical products that are designed to act at the molecular level, it is an inducer of interferon and is considered to be antiviral and immunomodulatory.
652:
191:
Energy envelope theory is a form of pacing that states patients should aim to stay within their "envelope" of available energy, and by avoiding exceeding their energy levels the worsening of symptoms after mental and physical exertion
144:) focuses on symptoms management, as no treatments that address the root cause of the illness are available. Pacing, or regulating one's activities to avoid triggering worse symptoms, is the most common management strategy for
345:
Hemispherx
Biopharma performed additional analyses on their data and submitted a new NDA to the FDA in 2012. After reviewing the data, the FDA did not approve the application citing "insufficient safety and efficacy data".
2817:
Freitas, J.; Santos, R.; Azevedo, E.; Costa, O.; Carvalho, M.; de
Freitas, A. F. (October 2000). "Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone".
2635:
Kakumanu, Sujani S.; Mende, Cathy N.; Lehman, Erik B.; Hughes, Kathleen; Craig, Timothy J. (September 2003). "Effect of topical nasal corticosteroids on patients with chronic fatigue syndrome and rhinitis".
525:
found no effect for the treatment. Another review concluded that "Given the weak evidence of benefit for immunotherapy, the potential harms indicate that it should not be offered as a treatment for CFS."
1674:
Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G (August 2010). "How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity".
644:
1641:. Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome No. 219 (Evidence Report/Technology Assessment). Agency for Healthcare Research and Quality (US). pp. 1–433.
3870:
1080:
3226:
Zachrisson O, Regland B, Jahreskog M, Jonsson M, Kron M, Gottfries CG (2002). "Treatment with staphylococcus toxoid in fibromyalgia/chronic fatigue syndrome--a randomised controlled trial".
500:
the treated patients compared to controls did not reach statistical significance. A 2006 review concluded that there is still insufficient evidence for immunological therapies of this type.
2725:
McKenzie R, O'Fallon A, Dale J, Demitrack M, Sharma G, Deloria M, et al. (1998). "Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial".
263:
Graded exercise therapy (GET) is a programme of physical activity that starts very slowly and gradually increases over time in fixed increments. Most public health bodies, including the
516:
outcomes only. The quality of both of these studies was considered poor. A 2007 review of research needs for ME/CFS concluded that trials for interferon beta are an important priority.
2246:
Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramírez G (September 2001). "Interventions for the treatment and management of chronic fatigue syndrome: a systematic review".
1925:
314:, although consistent and compelling supportive evidence is still lacking. A number of antiviral and antibacterial treatment studies have been conducted with inconsistent results.
688:
2452:
Pae CU, Marks DM, Patkar AA, Masand PS, Luyten P, Serretti A (July 2009). "Pharmacological treatment of chronic fatigue syndrome: focusing on the role of antidepressants".
3737:
3728:
2383:
141:
648:
280:
268:
46:
3461:
Malaguarnera M, Gargante MP, Cristaldi E, Colonna V, Messano M, Koverech A, et al. (2008). "Acetyl L-carnitine (ALC) treatment in elderly patients with fatigue".
1156:
2678:"Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review"
2538:
Valdizán Usón JR, Idiazábal Alecha MA (June 2008). "Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate".
883:
Van
Cauwenbergh D, De Kooning M, Ickmans K, Nijs J (October 2012). "How to exercise people with chronic fatigue syndrome: evidence-based practice guidelines".
331:
1466:
929:
Nijs J, Meeus M, De
Meirleir K (August 2006). "Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications".
558:
which includes ALC, a group of natural compounds that have an important role in cellular function. It is required for the transport of fatty acids into the
159:). Drugs have been used in experimental studies of the illness that have not been approved for market for any condition in the United States (for example,
3695:
684:
264:
1011:
760:
454:
342:) to market and sell Ampligen for treatment of ME/CFS. The FDA concluded that the two RCTs submitted "did not provide credible evidence of efficacy."
1157:
Myalgic
Encephalomyelitis – Adult & Paediatric: International Consensus Primer for Medical Practitioners Authors – International Consensus Panel.
1496:
Alhaboby, Zhraa A.; Barnes, James; Evans, Hala; Short, Emma (2018). "Disability and Cyber-Victimization". In Schatz, J.L.; George, Amber E. (eds.).
3271:"Current research priorities in chronic fatigue syndrome/myalgic encephalomyelitis: disease mechanisms, a diagnostic test and specific treatments"
1775:
1306:"Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves"
3721:
1257:"The role of changes in activity as a function of perceived available and expended energy in nonpharmacological treatment outcomes for ME/CFS"
2393:
1505:
1424:
807:
1929:
2495:
Van
Houdenhove B, Pae CU, Luyten P (February 2010). "Chronic fatigue syndrome: is there a role for non-antidepressant pharmacotherapy?".
1212:
Jason L, Muldowney K, Torres-Harding S (May 2008). "The Energy Envelope Theory and myalgic encephalomyelitis/chronic fatigue syndrome".
1354:
675:
307:
No pharmacological treatments have been established as a cure for ME/CFS, but various drugs are used to manage the symptoms of ME/CFS.
271:, consider it ineffective, and its safety is disputed. In particular, NICE removed their recommendation for this treatment in 2021.
107:
3714:
466:
1942:
79:
357:, and in 2019 the U.S. FDA regulatory requirements were met for exportation of rintatolimod from the United States to Argentina.
2306:
3803:
3751:
1731:
Adamowicz JL, Caikauskaite I, Friedberg F (November 2014). "Defining recovery in chronic fatigue syndrome: a critical review".
645:"Recommendations – Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management – Guidance"
1414:
86:
1522:
1108:"Energy Conservation/Envelope Theory Interventions to Help Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"
582:
A randomized controlled trial on patients diagnosed with post viral fatigue syndrome (PVFS) and deficient RBC levels, using
2409:
Jackson JL, O'Malley PG, Kroenke K (March 2006). "Antidepressants and cognitive-behavioral therapy for symptom syndromes".
3849:
3018:"Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome?"
569:
In 2008 a randomised double-blind placebo-controlled six-month trial on 96 aged subjects with CFS symptoms administering
443:
234:
152:
93:
3176:"Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome"
486:
was identified by two Norwegian doctors who were treating people who had cancer with rituximab; two people also had
368:
are often prescribed to ME/CFS patients. Their purpose can be to treat secondary depression or mood swings, but low
3808:
2282:
75:
1474:
372:
54:
677:
Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): An Updated Systematic Evidence Review
3839:
1883:
487:
311:
220:
has a limited amount and must choose which activities to do. Spoon theory is commonly used by people with CFS.
1662:
decreased work impairment (1 trial, n=480), and insufficient evidence for improved quality of life (no trials)
3844:
3761:
600:
296:
275:
258:
242:
193:
155:-approved medications for ME/CFS, although medications are sometimes used without approval for the illness (
145:
65:
50:
3361:
2330:"Efficacy of rintatolimod in the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)"
2111:"Graded exercise therapy does not restore the ability to work in ME/CFS – Rethinking of a Cochrane review"
1598:
1081:"Forward-ME and Oxford Brookes University announce results of the patient survey on CBT and GET in ME/CFS"
2161:"Treating chronic fatigue syndrome – a study into the scientific evidence for pharmacological treatments"
2028:
3377:"Complementary and alternative medicine for patients with chronic fatigue syndrome: A systematic review"
2969:"Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome"
2871:"Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome"
2588:"Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome"
1953:
583:
3701:
Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (NG206
1814:
512:. One RCT found an overall beneficial effect and the other showed some positive effects in relation to
3706:
3625:
Cox IM, Campbell MJ, Dowson D (March 1991). "Red blood cell magnesium and chronic fatigue syndrome".
3336:
2379:
965:
587:
542:
A 2008 review found insufficient evidence to recommend dietary supplements as a treatment in ME/CFS.
339:
335:
1441:
100:
369:
2192:"Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome?"
3650:
3607:
3563:
3269:
Kerr JR, Christian P, Hodgetts A, Langford PR, Devanur LD, Petty R, et al. (February 2007).
3251:
3205:
3156:
2949:
2851:
2563:
2520:
2477:
2434:
2052:
Larun, Lillebeth; Brurberg, Kjetil G.; Odgaard-Jensen, Jan; Price, Jonathan R. (2 October 2019).
1806:
1756:
1710:
1237:
993:
908:
739:
570:
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3642:
3599:
3555:
3514:
3478:
3443:
3416:
3398:
3350:
3300:
3243:
3197:
3148:
3098:
3047:
2998:
2941:
2920:"Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Where will the drugs come from?"
2900:
2892:
2843:
2835:
2799:
2781:
2742:
2707:
2653:
2645:
2617:
2555:
2512:
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2426:
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2221:
2172:
2138:
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2073:
2010:
2002:
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1798:
1748:
1702:
1652:
1587:
1501:
1420:
1335:
1286:
1229:
1191:
1168:
Jason LA, Melrose H, Lerman A, Burroughs V, Lewis K, King CP, Frankenberry EL (January 1999).
1137:
1059:
985:
946:
900:
862:
803:
731:
148:. Clinical management varies widely, with many patients receiving combinations of therapies.
3756:
3634:
3591:
3545:
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3406:
3388:
3340:
3290:
3282:
3235:
3187:
3140:
3088:
3078:
3037:
3029:
2988:
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2931:
2882:
2827:
2789:
2773:
2734:
2697:
2689:
2607:
2599:
2547:
2504:
2461:
2418:
2351:
2341:
2255:
2211:
2203:
2122:
2081:
2065:
1992:
1981:"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management"
1854:
1844:
1790:
1740:
1692:
1684:
1642:
1577:
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1365:
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1317:
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1181:
1127:
1119:
1049:
977:
938:
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852:
842:
795:
723:
3375:
Alraek, Terje; Lee, Myeong Soo; Choi, Tae-Young; Cao, Huijuan; Liu, Jianping (2011-10-07).
1106:
Jason LA, Brown M, Brown A, Evans M, Flores S, Grant-Holler E, Sunnquist M (January 2013).
574:
fatigue severity between groups when given a supplement containing 1200 mg carnitine.
1926:"Report of the Working Party on CFS/ME to the Chief Medical Officer for England and Wales"
789:
427:
399:
391:
1613:"Treatment of ME/CFS | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC"
1637:
Smith ME, Nelson HD, Haney E, Pappas M, Daeges M, Wasson N, McDonagh M (December 2014).
3834:
3829:
3595:
3550:
3533:
3411:
3376:
3345:
3324:
3295:
3270:
3093:
3066:
3042:
3017:
2993:
2968:
2794:
2761:
2702:
2677:
2612:
2587:
2356:
2329:
2216:
2191:
2110:
2086:
2053:
1859:
1832:
1582:
1557:
1330:
1305:
1281:
1256:
1132:
1107:
981:
857:
830:
447:
423:
365:
3239:
3192:
3175:
1794:
353:
Rintatolimod has been approved for marketing and treatment for persons with ME/CFS in
3864:
3824:
3638:
2953:
2314:
896:
513:
174:
Even when treated, the prognosis of ME/CFS is poor, with recovery considered “rare”.
3654:
3611:
3567:
3255:
3209:
3160:
2855:
2567:
2524:
2481:
2438:
2159:
Kreijkamp-Kaspers S, Brenu EW, Marshall S, Staines D, Van Driel ML (November 2011).
1810:
1760:
1241:
997:
912:
743:
2069:
1714:
1573:
1389:
1304:
O'connor K, Sunnquist M, Nicholson L, Jason LA, Newton JL, Strand EB (March 2019).
559:
327:
216:
164:
160:
3691:
3474:
2346:
1612:
3534:"Effect of high doses of essential fatty acids on the postviral fatigue syndrome"
1997:
1225:
1123:
3436:
Nihon Shinkei Seishin Yakurigaku Zasshi = Japanese Journal of Psychopharmacology
2029:"Diagnosis and Treatment of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome"
1638:
616:
442:
use for ME/CFS. Additionally, long-term use of these medications carry risks of
431:
395:
380:
286:
Even if graded exercise therapy is considered helpful, it does not cure ME/CFS.
17:
2936:
2919:
2777:
2693:
1980:
1186:
1169:
942:
310:
In subsets of patients, various viruses and bacteria have been reported as the
3766:
3510:
3116:
2508:
2465:
2422:
1744:
1688:
555:
509:
3668:
3402:
2896:
2839:
2785:
2738:
2649:
2551:
2259:
2134:
2077:
2006:
1442:"Pacing by Numbers: using your heart rate to stay inside the energy envelope"
1321:
1054:
1037:
829:
Luyten P, Van Houdenhove B, Pae CU, Kempke S, Van Wambeke P (December 2008).
3393:
3286:
2160:
1954:"Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) - Treatment"
1647:
966:"Randomised controlled trial of graded exercise in chronic fatigue syndrome"
847:
831:"Treatment of chronic fatigue syndrome: findings, principles and strategies"
551:
483:
403:
354:
168:
156:
3603:
3518:
3482:
3447:
3420:
3354:
3304:
3247:
3201:
3152:
3102:
3051:
3002:
2945:
2904:
2887:
2870:
2847:
2803:
2711:
2657:
2621:
2559:
2516:
2473:
2430:
2365:
2267:
2225:
2176:
2142:
2095:
2014:
1899:
1868:
1802:
1752:
1706:
1656:
1591:
1339:
1290:
1233:
1195:
1141:
1063:
1038:"[Patients' experience with treatment of chronic fatigue syndrome]"
989:
950:
904:
866:
735:
3646:
3559:
3033:
2746:
1849:
799:
3782:
3700:
469:
is of benefit for CFS patients, particularly in combination with CoQ10.
415:
3083:
2831:
2207:
2126:
1272:
419:
64:
if you can. Unsourced or poorly sourced material may be challenged and
2984:
2603:
1774:
Clark C, Buchwald D, MacIntyre A, Sharpe M, Wessely S (January 2002).
1697:
1500:. Jefferson, North Carolina: McFarland & Company. pp. 167ff.
3144:
2967:
Castro-Marrero J, Sáez-Francàs N, Santillo D, Alegre J (March 2017).
2586:
Castro-Marrero J, Sáez-Francàs N, Santillo D, Alegre J (March 2017).
727:
563:
379:
patients who received 12 weeks of CBT before starting treatment with
1903:
1831:
White PD, Sharpe MC, Chalder T, DeCesare JC, Walwyn R (March 2007).
1558:"Cognitive behaviour therapy for chronic fatigue syndrome in adults"
964:
Wallman KE, Morton AR, Goodman C, Grove R, Guilfoyle AM (May 2004).
199:
Energy Envelope Theory has been promoted by various patient groups.
375:
are sometimes prescribed to improve sleep quality and reduce pain.
2869:
Hoad, A.; Spickett, G.; Elliott, J.; Newton, J. (December 2008).
3323:
Reid S, Chalder T, Cleare A, Hotopf M, Wessely S (26 May 2011).
3710:
2307:"FDA Response Letter Regarding Approval of Ampligen for ME/CFS"
29:
330:
and found an overall beneficial effect. In December 2009 the
3318:
3316:
3314:
1170:"Managing chronic fatigue syndrome: overview and case study"
2676:
Chambers D, Bagnall AM, Hempel S, Forbes C (October 2006).
2190:
Newberry F, Hsieh SY, Wileman T, Carding SR (March 2018).
245:
and adapted to the illness rather than recovered from it.
2918:
Toogood PL, Clauw DJ, Phadke S, Hoffman D (March 2021).
2283:"FDA rejects Hemispherx's chronic fatigue drug Ampligen"
1498:
The Image of Disability: Essays on Media Representations
508:
A systematic review found two small RCTs that evaluated
167:). Rintatolimod has been approved for import and use in
755:
753:
438:
significance was noted as scoring poorly for validity.
61:
3174:
Andersson M, Bagby JR, Dyrehag L, Gottfries C (1998).
1075:
1073:
788:
Agrawal, Sudhir; Gait, Michael J., eds. (2019-02-11).
2875:
QJM: Monthly Journal of the Association of Physicians
1776:"Chronic fatigue syndrome: a step towards agreement"
3817:
3791:
3775:
3744:
2638:
The Journal of the American Osteopathic Association
1556:Price JR, Mitchell E, Tidy E, Hunot V (July 2008).
453:Fludrocortisone is commonly used for patients with
3871:Myalgic encephalomyelitis/chronic fatigue syndrome
3738:Myalgic encephalomyelitis/chronic fatigue syndrome
2762:"The effect of glucocorticoids on bone and muscle"
761:"Rintatolimod for severe Chronic Fatigue Syndrome"
674:Chou R, McDonagh M, Griffins J, Grusing S (2022).
142:myalgic encephalomyelitis/chronic fatigue syndrome
3532:Behan PO, Behan WM, Horrobin D (September 1990).
649:National Institute for Health and Care Excellence
2154:
2152:
3117:"Rituximab Fails to Improve Symptoms in ME/CFS"
2671:
2669:
2667:
2241:
2239:
2237:
2235:
2054:"Exercise therapy for chronic fatigue syndrome"
1726:
1724:
924:
922:
878:
876:
794:. Drug Discovery. RSC Publishing. p. 310.
2385:The Doctor's Guide to Chronic Fatigue Syndrome
1551:
1549:
1547:
60:Please review the contents of the article and
3722:
3221:
3219:
2581:
2579:
2577:
783:
781:
8:
2109:Vink, Mark; Vink-Niese, Friso (2020-01-01).
1419:. Demos Medical Publishing. pp. 54–55.
1207:
1205:
1036:Bjørkum T, Wang CE, Waterloo K (June 2009).
3065:Castro-Marrera, Jesus; et al. (2021).
3016:Castro-Marrero, Jesús; et al. (2015).
2058:The Cochrane Database of Systematic Reviews
1562:The Cochrane Database of Systematic Reviews
1416:What Nurses Know...Chronic Fatigue Syndrome
1255:Brown M, Khorana N, Jason LA (March 2011).
406:have been studied in the treatment of CFS.
3729:
3715:
3707:
3696:Centers for Disease Control and Prevention
3381:BMC Complementary and Alternative Medicine
885:European Journal of Clinical Investigation
685:Centers for Disease Control and Prevention
639:
637:
635:
3549:
3410:
3392:
3344:
3294:
3191:
3092:
3082:
3041:
2992:
2935:
2886:
2793:
2701:
2611:
2355:
2345:
2215:
2085:
1996:
1858:
1848:
1696:
1646:
1581:
1329:
1280:
1185:
1131:
1053:
856:
846:
455:postural orthostatic tachycardia syndrome
3669:"Does Vitamin B12 Help Relieve Fatigue?"
2682:Journal of the Royal Society of Medicine
1924:Working Party on CFS/ME (January 2002).
1042:Tidsskrift for den Norske Laegeforening
631:
3463:Archives of Gerontology and Geriatrics
3434:Inazu M, Matsumiya T (June 2008). "".
2334:Expert Review of Clinical Pharmacology
1928:. Department of Health. Archived from
791:Advances in Nucleic Acid Therapeutics
694:from the original on 14 February 2024
7:
1440:Campbell, Bruce (14 November 2009).
655:from the original on 8 February 2024
338:(NDA) by the developer of the drug (
243:postexertional symptom exacerbations
3596:10.1111/j.1600-0404.1999.tb00667.x
3551:10.1111/j.1600-0404.1990.tb04490.x
982:10.5694/j.1326-5377.2004.tb06019.x
25:
2454:Expert Opinion on Pharmacotherapy
1017:. Action for ME. 2008. p. 13
599:Positive results from a trial of
332:U.S. Food and Drug Administration
3360:
1882:Twisk FN, Maes M (August 2009).
1597:
1413:Steefel, Lorraine (2011-09-15).
970:The Medical Journal of Australia
897:10.1111/j.1365-2362.2012.02701.x
297:postexertional symptom flare-ups
203:Pacing with a heart rate monitor
126:
34:
2973:British Journal of Pharmacology
2760:Klein, Gordon L. (2015-09-01).
2592:British Journal of Pharmacology
1465:Miserandino, Christine (2003).
1355:"Managing your energy envelope"
2388:. Da Capo Press. p. 163.
2070:10.1002/14651858.CD003200.pub8
1574:10.1002/14651858.CD001027.pub2
1261:Journal of Clinical Psychology
62:add the appropriate references
1:
3850:Whittemore Peterson Institute
3584:Acta Neurologica Scandinavica
3538:Acta Neurologica Scandinavica
3475:10.1016/j.archger.2007.03.012
3275:Journal of Clinical Pathology
3240:10.1016/s1090-3801(02)00044-7
3193:10.1016/S1090-3801(98)90006-4
2347:10.1586/17512433.2016.1172960
2287:Philadelphia Business Journal
2281:George J (December 3, 2009).
1795:10.1016/S0140-6736(02)07336-1
1523:"Reclaiming 'Chronic Illness"
495:Staphylococcal toxoid vaccine
3639:10.1016/0140-6736(91)91371-Z
2033:effectivehealthcare.ahrq.gov
1998:10.1016/j.mayocp.2021.07.004
1226:10.3928/08910162-20080501-06
1124:10.1080/21641846.2012.733602
1012:"Survey Summary Report 2008"
465:There is some evidence that
444:steroid-induced osteoporosis
235:Cognitive behavioral therapy
224:Cognitive behavioral therapy
153:Food and Drug Administration
3133:Annals of Internal Medicine
2820:Clinical Autonomic Research
2766:Osteoporosis and Sarcopenia
2165:Australian Family Physician
1888:Neuro Endocrinology Letters
1390:"Pacing - Emerge Australia"
1353:Campbell, B (Winter 2009).
716:Annals of Internal Medicine
334:(FDA) refused to approve a
47:reliable medical references
3887:
3325:"Chronic fatigue syndrome"
2937:10.1016/j.phrs.2021.105465
2778:10.1016/j.afos.2015.07.008
2694:10.1177/014107680609901012
1446:ME/CFS South Australia Inc
1187:10.1177/216507999904700104
943:10.1016/j.math.2006.03.008
312:causative agents of ME/CFS
256:
2509:10.1517/14656560903487744
2466:10.1517/14656560902988510
2423:10.1017/S1092852900014383
2328:Mitchell WM (June 2016).
1745:10.1007/s11136-014-0705-9
1689:10.1017/S0033291709992212
1530:Centre for Welfare Reform
651:(NICE). 29 October 2021.
373:tricyclic antidepressants
53:or relies too heavily on
3840:Open Medicine Foundation
3228:European Journal of Pain
3180:European Journal of Pain
2924:Pharmacological Research
2739:10.1001/jama.280.12.1061
2552:10.1586/14737175.8.6.917
2497:Expert Opin Pharmacother
2260:10.1001/jama.286.11.1360
1733:Quality of Life Research
1521:Hale, Catherine (2018).
1322:10.1177/1742395317746470
1055:10.4045/tidsskr.09.35791
835:Psychiatry Investigation
562:during the breakdown of
488:chronic fatigue syndrome
3845:Solve ME/CFS Initiative
3762:Post-exertional malaise
3703:- NICE guideline (2021)
3511:10.1093/qjmed/95.10.677
3394:10.1186/1472-6882-11-87
3287:10.1136/jcp.2006.042374
1985:Mayo Clinic Proceedings
1648:10.23970/AHRQEPCERTA219
1471:But You Don't Look Sick
1364:: 28–31. Archived from
848:10.4306/pi.2008.5.4.209
615:Both oral and injected
259:Graded exercise therapy
253:Graded exercise therapy
194:post-exertional malaise
146:post-exertional malaise
1677:Psychological Medicine
187:Energy envelope theory
76:"Management of ME/CFS"
3752:Clinical descriptions
3329:BMJ Clinical Evidence
3034:10.1089/ars.2014.6181
3022:Antioxid Redox Signal
1850:10.1186/1471-2377-7-6
800:10.1039/9781788015714
584:essential fatty acids
578:Essential fatty acids
3337:BMJ Publishing Group
2888:10.1093/qjmed/hcn123
2540:Expert Rev Neurother
1639:"July 2016 Addendum"
588:evening primrose oil
529:Alternative medicine
482:A potential use for
434:, has been studied.
340:Hemispherx Biopharma
336:New Drug Application
138:Management of ME/CFS
27:Aspect of healthcare
3792:Society and history
3692:Treatment of ME/CFS
1477:on 17 November 2019
1362:The CFIDS Chronicle
767:. 19 September 2019
538:Dietary supplements
3084:10.3390/nu13082658
2832:10.1007/BF02281112
2208:10.1042/CS20171330
2127:10.3233/WOR-203174
1467:"The Spoon Theory"
1273:10.1002/jclp.20744
571:acetyl L-carnitine
422:hormones, such as
326:One RCT evaluated
281:definitions of CFS
3858:
3857:
2985:10.1111/bph.13702
2604:10.1111/bph.13702
2395:978-0-201-40797-6
1991:(11): 2861–2878.
1941:alternative URL:
1507:978-1-4766-6945-8
1426:978-1-61705-028-2
1155:Steven S (2012).
809:978-1-78801-209-6
135:
134:
111:
16:(Redirected from
3878:
3809:Notable patients
3731:
3724:
3717:
3708:
3680:
3679:
3677:
3676:
3665:
3659:
3658:
3633:(8744): 757–60.
3622:
3616:
3615:
3578:
3572:
3571:
3553:
3529:
3523:
3522:
3493:
3487:
3486:
3458:
3452:
3451:
3431:
3425:
3424:
3414:
3396:
3372:
3366:
3365:
3364:
3358:
3348:
3320:
3309:
3308:
3298:
3266:
3260:
3259:
3223:
3214:
3213:
3195:
3171:
3165:
3164:
3145:10.7326/M18-1451
3127:
3121:
3120:
3113:
3107:
3106:
3096:
3086:
3062:
3056:
3055:
3045:
3013:
3007:
3006:
2996:
2964:
2958:
2957:
2939:
2915:
2909:
2908:
2890:
2866:
2860:
2859:
2814:
2808:
2807:
2797:
2757:
2751:
2750:
2722:
2716:
2715:
2705:
2673:
2662:
2661:
2632:
2626:
2625:
2615:
2583:
2572:
2571:
2535:
2529:
2528:
2492:
2486:
2485:
2449:
2443:
2442:
2406:
2400:
2399:
2376:
2370:
2369:
2359:
2349:
2325:
2319:
2318:
2313:. Archived from
2303:
2297:
2296:
2294:
2293:
2278:
2272:
2271:
2243:
2230:
2229:
2219:
2196:Clinical Science
2187:
2181:
2180:
2156:
2147:
2146:
2106:
2100:
2099:
2089:
2049:
2043:
2042:
2040:
2039:
2025:
2019:
2018:
2000:
1975:
1969:
1968:
1966:
1965:
1950:
1944:
1940:
1938:
1937:
1921:
1915:
1914:
1912:
1911:
1902:. Archived from
1879:
1873:
1872:
1862:
1852:
1828:
1822:
1821:
1819:
1813:. Archived from
1780:
1771:
1765:
1764:
1728:
1719:
1718:
1700:
1671:
1665:
1664:
1650:
1634:
1628:
1627:
1625:
1624:
1609:
1603:
1602:
1601:
1595:
1585:
1553:
1542:
1541:
1539:
1537:
1527:
1518:
1512:
1511:
1493:
1487:
1486:
1484:
1482:
1473:. Archived from
1462:
1456:
1455:
1453:
1452:
1437:
1431:
1430:
1410:
1404:
1403:
1401:
1400:
1394:Emerge Australia
1386:
1380:
1379:
1377:
1376:
1370:
1359:
1350:
1344:
1343:
1333:
1301:
1295:
1294:
1284:
1252:
1246:
1245:
1209:
1200:
1199:
1189:
1165:
1159:
1152:
1146:
1145:
1135:
1103:
1097:
1096:
1094:
1092:
1077:
1068:
1067:
1057:
1033:
1027:
1026:
1024:
1022:
1016:
1008:
1002:
1001:
961:
955:
954:
926:
917:
916:
880:
871:
870:
860:
850:
826:
820:
819:
817:
816:
785:
776:
775:
773:
772:
757:
748:
747:
728:10.7326/M15-0114
710:
704:
703:
701:
699:
693:
682:
671:
665:
664:
662:
660:
641:
392:Psychostimulants
130:
129:
121:
118:
112:
110:
69:
38:
37:
30:
21:
18:ME/CFS therapies
3886:
3885:
3881:
3880:
3879:
3877:
3876:
3875:
3861:
3860:
3859:
3854:
3813:
3787:
3771:
3740:
3735:
3688:
3683:
3674:
3672:
3667:
3666:
3662:
3624:
3623:
3619:
3580:
3579:
3575:
3531:
3530:
3526:
3495:
3494:
3490:
3460:
3459:
3455:
3438:(in Japanese).
3433:
3432:
3428:
3374:
3373:
3369:
3359:
3322:
3321:
3312:
3268:
3267:
3263:
3225:
3224:
3217:
3173:
3172:
3168:
3129:
3128:
3124:
3115:
3114:
3110:
3064:
3063:
3059:
3015:
3014:
3010:
2966:
2965:
2961:
2917:
2916:
2912:
2881:(12): 961–965.
2868:
2867:
2863:
2816:
2815:
2811:
2759:
2758:
2754:
2733:(12): 1061–66.
2724:
2723:
2719:
2675:
2674:
2665:
2634:
2633:
2629:
2585:
2584:
2575:
2537:
2536:
2532:
2494:
2493:
2489:
2460:(10): 1561–70.
2451:
2450:
2446:
2408:
2407:
2403:
2396:
2378:
2377:
2373:
2327:
2326:
2322:
2305:
2304:
2300:
2291:
2289:
2280:
2279:
2275:
2254:(11): 1360–68.
2245:
2244:
2233:
2189:
2188:
2184:
2158:
2157:
2150:
2108:
2107:
2103:
2064:(3): CD003200.
2051:
2050:
2046:
2037:
2035:
2027:
2026:
2022:
1977:
1976:
1972:
1963:
1961:
1952:
1951:
1947:
1935:
1933:
1923:
1922:
1918:
1909:
1907:
1881:
1880:
1876:
1830:
1829:
1825:
1817:
1789:(9301): 97–98.
1778:
1773:
1772:
1768:
1730:
1729:
1722:
1673:
1672:
1668:
1636:
1635:
1631:
1622:
1620:
1611:
1610:
1606:
1596:
1568:(3): CD001027.
1555:
1554:
1545:
1535:
1533:
1525:
1520:
1519:
1515:
1508:
1495:
1494:
1490:
1480:
1478:
1464:
1463:
1459:
1450:
1448:
1439:
1438:
1434:
1427:
1412:
1411:
1407:
1398:
1396:
1388:
1387:
1383:
1374:
1372:
1368:
1357:
1352:
1351:
1347:
1310:Chronic Illness
1303:
1302:
1298:
1254:
1253:
1249:
1211:
1210:
1203:
1167:
1166:
1162:
1153:
1149:
1105:
1104:
1100:
1090:
1088:
1079:
1078:
1071:
1048:(12): 1214–16.
1035:
1034:
1030:
1020:
1018:
1014:
1010:
1009:
1005:
963:
962:
958:
928:
927:
920:
891:(10): 1136–44.
882:
881:
874:
828:
827:
823:
814:
812:
810:
787:
786:
779:
770:
768:
759:
758:
751:
712:
711:
707:
697:
695:
691:
680:
673:
672:
668:
658:
656:
643:
642:
633:
629:
620:
613:
611:
597:
580:
548:
540:
531:
522:
506:
497:
480:
475:
463:
428:fludrocortisone
414:Treatment with
412:
400:methylphenidate
389:
366:Antidepressants
363:
361:Antidepressants
320:
305:
292:
261:
255:
226:
214:
205:
189:
180:
131:
127:
122:
116:
113:
70:
59:
55:primary sources
39:
35:
28:
23:
22:
15:
12:
11:
5:
3884:
3882:
3874:
3873:
3863:
3862:
3856:
3855:
3853:
3852:
3847:
3842:
3837:
3835:ME Research UK
3832:
3830:ME Association
3827:
3821:
3819:
3815:
3814:
3812:
3811:
3806:
3801:
3795:
3793:
3789:
3788:
3786:
3785:
3779:
3777:
3773:
3772:
3770:
3769:
3764:
3759:
3754:
3748:
3746:
3745:Medical issues
3742:
3741:
3736:
3734:
3733:
3726:
3719:
3711:
3705:
3704:
3698:
3687:
3686:External links
3684:
3682:
3681:
3660:
3617:
3573:
3524:
3505:(10): 677–83.
3488:
3453:
3426:
3367:
3310:
3261:
3215:
3166:
3122:
3108:
3057:
3028:(8): 679–685.
3008:
2979:(5): 345–369.
2959:
2910:
2861:
2826:(5): 293–299.
2809:
2752:
2717:
2688:(10): 506–20.
2663:
2644:(9): 423–427.
2627:
2573:
2530:
2487:
2444:
2401:
2394:
2380:Bell, David S.
2371:
2320:
2317:on 2017-01-13.
2298:
2273:
2231:
2182:
2171:(11): 907–12.
2148:
2121:(2): 283–308.
2101:
2044:
2020:
1970:
1945:
1916:
1874:
1823:
1820:on 2007-10-12.
1766:
1739:(9): 2407–16.
1720:
1683:(8): 1281–87.
1666:
1629:
1604:
1543:
1513:
1506:
1488:
1457:
1432:
1425:
1405:
1381:
1345:
1296:
1247:
1201:
1160:
1147:
1118:(1–2): 27–42.
1098:
1087:. 3 April 2019
1085:ME Association
1069:
1028:
1003:
956:
931:Manual Therapy
918:
872:
821:
808:
777:
749:
722:(12): 841–50.
705:
666:
630:
628:
625:
618:
612:
609:
606:
596:
593:
586:consisting of
579:
576:
547:
544:
539:
536:
530:
527:
521:
518:
505:
502:
496:
493:
479:
476:
474:
471:
462:
459:
448:muscle atrophy
424:hydrocortisone
411:
408:
388:
385:
362:
359:
319:
316:
304:
301:
291:
288:
257:Main article:
254:
251:
225:
222:
213:
210:
204:
201:
188:
185:
179:
176:
133:
132:
125:
123:
42:
40:
33:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
3883:
3872:
3869:
3868:
3866:
3851:
3848:
3846:
3843:
3841:
3838:
3836:
3833:
3831:
3828:
3826:
3825:Action for ME
3823:
3822:
3820:
3818:Organizations
3816:
3810:
3807:
3805:
3804:Controversies
3802:
3800:
3797:
3796:
3794:
3790:
3784:
3781:
3780:
3778:
3774:
3768:
3765:
3763:
3760:
3758:
3755:
3753:
3750:
3749:
3747:
3743:
3739:
3732:
3727:
3725:
3720:
3718:
3713:
3712:
3709:
3702:
3699:
3697:
3693:
3690:
3689:
3685:
3670:
3664:
3661:
3656:
3652:
3648:
3644:
3640:
3636:
3632:
3628:
3621:
3618:
3613:
3609:
3605:
3601:
3597:
3593:
3590:(2): 112–16.
3589:
3585:
3577:
3574:
3569:
3565:
3561:
3557:
3552:
3547:
3544:(3): 209–16.
3543:
3539:
3535:
3528:
3525:
3520:
3516:
3512:
3508:
3504:
3500:
3492:
3489:
3484:
3480:
3476:
3472:
3469:(2): 181–90.
3468:
3464:
3457:
3454:
3449:
3445:
3442:(3): 113–20.
3441:
3437:
3430:
3427:
3422:
3418:
3413:
3408:
3404:
3400:
3395:
3390:
3386:
3382:
3378:
3371:
3368:
3363:
3356:
3352:
3347:
3342:
3338:
3334:
3330:
3326:
3319:
3317:
3315:
3311:
3306:
3302:
3297:
3292:
3288:
3284:
3281:(2): 113–16.
3280:
3276:
3272:
3265:
3262:
3257:
3253:
3249:
3245:
3241:
3237:
3234:(6): 455–66.
3233:
3229:
3222:
3220:
3216:
3211:
3207:
3203:
3199:
3194:
3189:
3186:(2): 133–42.
3185:
3181:
3177:
3170:
3167:
3162:
3158:
3154:
3150:
3146:
3142:
3139:(9): 585–93.
3138:
3134:
3126:
3123:
3118:
3112:
3109:
3104:
3100:
3095:
3090:
3085:
3080:
3076:
3072:
3068:
3061:
3058:
3053:
3049:
3044:
3039:
3035:
3031:
3027:
3023:
3019:
3012:
3009:
3004:
3000:
2995:
2990:
2986:
2982:
2978:
2974:
2970:
2963:
2960:
2955:
2951:
2947:
2943:
2938:
2933:
2929:
2925:
2921:
2914:
2911:
2906:
2902:
2898:
2894:
2889:
2884:
2880:
2876:
2872:
2865:
2862:
2857:
2853:
2849:
2845:
2841:
2837:
2833:
2829:
2825:
2821:
2813:
2810:
2805:
2801:
2796:
2791:
2787:
2783:
2779:
2775:
2771:
2767:
2763:
2756:
2753:
2748:
2744:
2740:
2736:
2732:
2728:
2721:
2718:
2713:
2709:
2704:
2699:
2695:
2691:
2687:
2683:
2679:
2672:
2670:
2668:
2664:
2659:
2655:
2651:
2647:
2643:
2639:
2631:
2628:
2623:
2619:
2614:
2609:
2605:
2601:
2598:(5): 345–69.
2597:
2593:
2589:
2582:
2580:
2578:
2574:
2569:
2565:
2561:
2557:
2553:
2549:
2546:(6): 917–27.
2545:
2541:
2534:
2531:
2526:
2522:
2518:
2514:
2510:
2506:
2503:(2): 215–23.
2502:
2498:
2491:
2488:
2483:
2479:
2475:
2471:
2467:
2463:
2459:
2455:
2448:
2445:
2440:
2436:
2432:
2428:
2424:
2420:
2417:(3): 212–22.
2416:
2412:
2411:CNS Spectrums
2405:
2402:
2397:
2391:
2387:
2386:
2381:
2375:
2372:
2367:
2363:
2358:
2353:
2348:
2343:
2340:(6): 755–70.
2339:
2335:
2331:
2324:
2321:
2316:
2312:
2308:
2302:
2299:
2288:
2284:
2277:
2274:
2269:
2265:
2261:
2257:
2253:
2249:
2242:
2240:
2238:
2236:
2232:
2227:
2223:
2218:
2213:
2209:
2205:
2202:(5): 523–42.
2201:
2197:
2193:
2186:
2183:
2178:
2174:
2170:
2166:
2162:
2155:
2153:
2149:
2144:
2140:
2136:
2132:
2128:
2124:
2120:
2116:
2112:
2105:
2102:
2097:
2093:
2088:
2083:
2079:
2075:
2071:
2067:
2063:
2059:
2055:
2048:
2045:
2034:
2030:
2024:
2021:
2016:
2012:
2008:
2004:
1999:
1994:
1990:
1986:
1982:
1974:
1971:
1959:
1955:
1949:
1946:
1943:
1932:on 2011-03-22
1931:
1927:
1920:
1917:
1906:on 2011-02-24
1905:
1901:
1897:
1894:(3): 284–99.
1893:
1889:
1885:
1878:
1875:
1870:
1866:
1861:
1856:
1851:
1846:
1842:
1838:
1837:BMC Neurology
1834:
1827:
1824:
1816:
1812:
1808:
1804:
1800:
1796:
1792:
1788:
1784:
1777:
1770:
1767:
1762:
1758:
1754:
1750:
1746:
1742:
1738:
1734:
1727:
1725:
1721:
1716:
1712:
1708:
1704:
1699:
1694:
1690:
1686:
1682:
1678:
1670:
1667:
1663:
1658:
1654:
1649:
1644:
1640:
1633:
1630:
1618:
1614:
1608:
1605:
1600:
1593:
1589:
1584:
1579:
1575:
1571:
1567:
1563:
1559:
1552:
1550:
1548:
1544:
1531:
1524:
1517:
1514:
1509:
1503:
1499:
1492:
1489:
1476:
1472:
1468:
1461:
1458:
1447:
1443:
1436:
1433:
1428:
1422:
1418:
1417:
1409:
1406:
1395:
1391:
1385:
1382:
1371:on 2020-09-27
1367:
1363:
1356:
1349:
1346:
1341:
1337:
1332:
1327:
1323:
1319:
1315:
1311:
1307:
1300:
1297:
1292:
1288:
1283:
1278:
1274:
1270:
1267:(3): 253–60.
1266:
1262:
1258:
1251:
1248:
1243:
1239:
1235:
1231:
1227:
1223:
1220:(5): 189–95.
1219:
1215:
1214:AAOHN Journal
1208:
1206:
1202:
1197:
1193:
1188:
1183:
1179:
1175:
1174:AAOHN Journal
1171:
1164:
1161:
1158:
1151:
1148:
1143:
1139:
1134:
1129:
1125:
1121:
1117:
1113:
1109:
1102:
1099:
1086:
1082:
1076:
1074:
1070:
1065:
1061:
1056:
1051:
1047:
1043:
1039:
1032:
1029:
1013:
1007:
1004:
999:
995:
991:
987:
983:
979:
976:(9): 444–48.
975:
971:
967:
960:
957:
952:
948:
944:
940:
937:(3): 187–91.
936:
932:
925:
923:
919:
914:
910:
906:
902:
898:
894:
890:
886:
879:
877:
873:
868:
864:
859:
854:
849:
844:
841:(4): 209–12.
840:
836:
832:
825:
822:
811:
805:
801:
797:
793:
792:
784:
782:
778:
766:
762:
756:
754:
750:
745:
741:
737:
733:
729:
725:
721:
717:
709:
706:
690:
686:
679:
678:
670:
667:
654:
650:
646:
640:
638:
636:
632:
626:
624:
621:
607:
605:
602:
594:
592:
589:
585:
577:
575:
572:
567:
565:
561:
557:
553:
545:
543:
537:
535:
528:
526:
519:
517:
515:
514:immunological
511:
503:
501:
494:
492:
489:
485:
477:
473:Immunotherapy
472:
470:
468:
460:
458:
456:
451:
449:
445:
439:
435:
433:
429:
425:
421:
417:
409:
407:
405:
401:
397:
393:
386:
384:
382:
376:
374:
371:
367:
360:
358:
356:
351:
347:
343:
341:
337:
333:
329:
324:
317:
315:
313:
308:
302:
300:
298:
289:
287:
284:
282:
277:
272:
270:
266:
260:
252:
250:
246:
244:
238:
236:
230:
223:
221:
218:
211:
209:
202:
200:
197:
195:
186:
184:
177:
175:
172:
170:
166:
162:
158:
154:
151:There are no
149:
147:
143:
139:
124:
120:
109:
106:
102:
99:
95:
92:
88:
85:
81:
78: –
77:
73:
72:Find sources:
67:
63:
57:
56:
52:
48:
43:This article
41:
32:
31:
19:
3673:. Retrieved
3663:
3630:
3626:
3620:
3587:
3583:
3576:
3541:
3537:
3527:
3502:
3498:
3491:
3466:
3462:
3456:
3439:
3435:
3429:
3384:
3380:
3370:
3332:
3328:
3278:
3274:
3264:
3231:
3227:
3183:
3179:
3169:
3136:
3132:
3125:
3111:
3074:
3070:
3060:
3025:
3021:
3011:
2976:
2972:
2962:
2927:
2923:
2913:
2878:
2874:
2864:
2823:
2819:
2812:
2772:(1): 39–45.
2769:
2765:
2755:
2730:
2726:
2720:
2685:
2681:
2641:
2637:
2630:
2595:
2591:
2543:
2539:
2533:
2500:
2496:
2490:
2457:
2453:
2447:
2414:
2410:
2404:
2384:
2374:
2337:
2333:
2323:
2315:the original
2310:
2301:
2290:. Retrieved
2286:
2276:
2251:
2247:
2199:
2195:
2185:
2168:
2164:
2118:
2114:
2104:
2061:
2057:
2047:
2036:. Retrieved
2032:
2023:
1988:
1984:
1973:
1962:. Retrieved
1960:. 2017-10-20
1957:
1948:
1934:. Retrieved
1930:the original
1919:
1908:. Retrieved
1904:the original
1891:
1887:
1877:
1840:
1836:
1826:
1815:the original
1786:
1782:
1769:
1736:
1732:
1680:
1676:
1669:
1660:
1632:
1621:. Retrieved
1619:. 2019-11-19
1616:
1607:
1565:
1561:
1534:. Retrieved
1532:. p. 28
1529:
1516:
1497:
1491:
1479:. Retrieved
1475:the original
1470:
1460:
1449:. Retrieved
1445:
1435:
1415:
1408:
1397:. Retrieved
1393:
1384:
1373:. Retrieved
1366:the original
1361:
1348:
1316:(1): 51–60.
1313:
1309:
1299:
1264:
1260:
1250:
1217:
1213:
1180:(1): 17–21.
1177:
1173:
1163:
1150:
1115:
1111:
1101:
1089:. Retrieved
1084:
1045:
1041:
1031:
1019:. Retrieved
1006:
973:
969:
959:
934:
930:
888:
884:
838:
834:
824:
813:. Retrieved
790:
769:. Retrieved
764:
719:
715:
708:
696:. Retrieved
676:
669:
657:. Retrieved
614:
598:
581:
568:
560:mitochondria
549:
541:
532:
523:
507:
498:
481:
464:
452:
440:
436:
430:, and nasal
413:
390:
377:
364:
352:
348:
344:
328:rintatolimod
325:
321:
318:Rintatolimod
309:
306:
293:
285:
273:
262:
247:
239:
231:
227:
217:Spoon theory
215:
212:Spoon theory
206:
198:
190:
181:
173:
165:rintatolimod
161:isoprinosine
150:
137:
136:
114:
104:
97:
90:
83:
71:
51:verification
44:
3077:(8): 2658.
1617:www.cdc.gov
432:flunisolide
396:amphetamine
381:mirtazapine
117:August 2021
45:needs more
3767:2-day CPET
3675:2010-12-10
3671:. Medscape
2930:: 105465.
2292:2010-02-12
2038:2024-03-17
1964:2024-03-17
1936:2009-03-18
1910:2010-08-17
1698:2066/88308
1623:2020-05-23
1451:2020-05-23
1399:2020-05-23
1375:2020-05-26
815:2020-05-26
771:2020-05-26
627:References
556:amino acid
510:interferon
504:Interferon
387:Stimulants
87:newspapers
3757:Treatment
3403:1472-6882
3387:(1): 87.
3071:Nutrients
2954:231787959
2897:1460-2393
2840:0959-9851
2786:2405-5255
2650:0098-6151
2135:1051-9815
2078:1469-493X
2007:0025-6196
617:vitamin B
608:Vitamin B
601:magnesium
595:Magnesium
552:Carnitine
546:Carnitine
484:rituximab
478:Rituximab
404:modafinil
355:Argentina
169:Argentina
157:off-label
3865:Category
3783:DecodeME
3776:Research
3655:22160099
3612:23870977
3604:10071170
3568:31690317
3519:12324640
3483:17658628
3448:18646596
3421:21982120
3355:21615974
3305:16935968
3256:21526347
3248:12413434
3210:46726070
3202:10700309
3161:91186383
3153:30934066
3103:34444817
3052:25386668
3003:28052319
2946:33529750
2905:18805903
2856:20843222
2848:11198485
2804:26557727
2712:17021301
2658:14527077
2622:28052319
2568:37482754
2560:18505357
2525:34827174
2517:20088743
2482:20727319
2474:19514866
2439:46719420
2431:16575378
2382:(1994).
2366:27045557
2268:11560542
2226:29523751
2177:22059223
2143:32568149
2096:31577366
2015:34454716
1900:19855350
1869:17397525
1811:38526912
1803:11809249
1761:13609292
1753:24791749
1707:20047707
1657:30313001
1592:18646067
1340:29231037
1291:21254053
1242:25558691
1234:18578185
1196:10205371
1142:23504301
1064:19521443
998:16924241
990:15115421
951:16781183
913:24546500
905:22725992
867:20046339
744:28576363
736:26075755
698:30 March
689:Archived
653:Archived
416:steroids
410:Hormones
394:such as
290:Recovery
276:Cochrane
3799:History
3694:by the
3647:1672392
3560:2270749
3412:3201900
3346:3275316
3296:1860619
3094:8399248
3043:4346380
2994:5301046
2795:4635469
2747:9757853
2703:1592057
2613:5301046
2357:4917909
2217:5843715
2087:6953363
1860:2147058
1715:1706713
1583:7028002
1331:5750135
1282:3164291
1133:3596172
1112:Fatigue
1021:8 March
858:2796012
765:fda.gov
659:9 March
420:thyroid
274:A 2019
101:scholar
66:removed
3653:
3645:
3627:Lancet
3610:
3602:
3566:
3558:
3517:
3481:
3446:
3419:
3409:
3401:
3353:
3343:
3303:
3293:
3254:
3246:
3208:
3200:
3159:
3151:
3101:
3091:
3050:
3040:
3001:
2991:
2952:
2944:
2903:
2895:
2854:
2846:
2838:
2802:
2792:
2784:
2745:
2710:
2700:
2656:
2648:
2620:
2610:
2566:
2558:
2523:
2515:
2480:
2472:
2437:
2429:
2392:
2364:
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