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A structured evidence atlas for ME/CFS research.

6,113 studies on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), classified by diagnostic criteria, evidence level, and post-exertional malaise status. Organised into research domains covering immune dysregulation, neuroinflammation, autonomic dysfunction, metabolic dysfunction, Long COVID overlap, and more.

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What is ME/CFS?What is PEM?Research by topicFAQ

Landmark Research

Foundational studies that shaped the understanding of ME/CFS.

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E1 ReplicatedPEM requiredModerate confidenceObservationalEditor reviewed

Metabolic features of chronic fatigue syndrome

Robert K. Naviaux, Jane C. Naviaux, Kefeng Li et al.·Proceedings of the National Academy of Sciences (PNAS)·2016·n=84

This study analyzed blood metabolites from 84 ME/CFS patients and 45 healthy controls using untargeted metabolomics. Researchers found 80% of the abnormal metabolites were decreased in ME/CFS patients, suggesting a hypometabolic state — the body running in energy conservation mode. The pattern resembled a 'dauer-like' state seen in organisms under stress.

BiomarkersMetabolic Dysfunction
E1 ReplicatedPEM requiredModerate confidenceObservationalEditor reviewed

Cardiopulmonary exercise testing and post-exertional malaise in ME/CFS: A retrospective analysis

Staci R. Stevens, Christopher R. Snell, Jared N. Stevens et al.·Journal of Translational Medicine·2018·n=51

ME/CFS patients underwent two consecutive days of cardiopulmonary exercise testing (CPET). On the second day, patients showed significantly reduced VO2 max and anaerobic threshold compared to the first day — and compared to healthy and disease controls who recovered normally. This objective impairment matches the subjective PEM experience.

DiagnosticsPost-Exertional Malaise
E0 ConsensusPEM requiredHigher confidenceGuidelineEditor reviewed

Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness

Institute of Medicine Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome·National Academies Press·2015

The US Institute of Medicine reviewed over 9,000 scientific articles to establish new diagnostic criteria for ME/CFS. The report introduced SEID (Systemic Exertion Intolerance Disease) as a proposed name and established that ME/CFS is a serious, chronic, complex systemic disease. New criteria require PEM, unrefreshing sleep, plus cognitive impairment or orthostatic intolerance.

DiagnosticsPost-Exertional Malaise
E2 ModeratePEM unclearPreliminaryReview-NarrativeEditor reviewed

The neuroinflammatory hypothesis of chronic fatigue syndrome/myalgic encephalomyelitis: an update

Jarred W. Younger, Linda Yan, Sean Mackey·Journal of Neuroinflammation·2014·n=18

Using thermography and brain temperature imaging at Stanford, this study found evidence consistent with neuroinflammation — specifically elevated brain temperature — in ME/CFS patients compared to healthy controls. Brain regions associated with pain and fatigue showed the strongest signal.

Neuroinflammation

Research Domains

Structured synthesis of what is known, uncertain, and emerging across ME/CFS research.

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Recently Added

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E0 ConsensusPEM requiredModerate confidenceMethods-PaperEditor reviewed

Recommended long COVID outcome measures and their implications for clinical trial design, with a focus on post-exertional malaise.

Soares, Letícia, Davis, Hannah, Spier, Ezra et al.·EBioMedicine·2026

This paper provides guidance for researchers designing clinical trials to test treatments for long COVID, with special attention to post-exertional malaise (PEM)—a key symptom where people feel much worse after physical or mental activity. The authors recommend that trials should carefully measure patients at the start, track them over time, include a placebo group for comparison, and make sure patients in different treatment groups have similar severity of illness. The paper highlights that the field urgently needs funding to develop better ways to measure these outcomes before large-scale treatment trials can succeed.

Post-Exertional Malaise
E0 ConsensusPEM unclearModerate confidenceSystematic-ReviewEditor reviewed

Evaluating working memory functioning in individuals with myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review and meta-analysis.

Penson, Maddison, Kelly, Kate·Psychology, health & medicine·2026

This study reviewed 34 research papers to understand how ME/CFS affects working memory—the ability to hold and use information in your mind briefly. The researchers found that people with ME/CFS have significant difficulties with verbal working memory (remembering words and language), but their ability to remember visual information (like images or patterns) appeared similar to people without ME/CFS. This suggests that cognitive problems in ME/CFS may affect certain types of thinking more than others.

Cognitive Impairment
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Understanding concussion in myalgic encephalomyelitis/chronic fatigue syndrome: Findings from the 2023 National Health Interview study.

Sirotiak, Zoe, Adamowicz, Jenna L, Thomas, Emily B K·Brain injury·2026

This study found that people with ME/CFS are nearly 5 times more likely to have had a concussion in the past year compared to people without ME/CFS. People with ME/CFS also experienced more falls and dizziness or balance problems. The researchers suggest that doctors should screen patients with ME/CFS more carefully for concussions and take steps to reduce their concussion risk.

Autonomic Nervous System

The Paradigm Shift Over Time

How the share of biomedical vs. psychosomatic research has changed year by year. Based on 6,113 public studies (3-year rolling average).

Biomedical 71%Psychosomatic 11%Neutral 18%

The Paradigm Shift

How has the balance of biomedical vs. psychosomatic research shifted over the decades? Based on 6113 public studies in the atlas.

All studies (6113)61% biomedical
Biomedical 61%Neutral 21%Psychosomatic 18%

Decade by decade

1990s
58% biomedical22% neutral20% psychosomatic
2000s
55% biomedical21% neutral24% psychosomatic
2010s
61% biomedical20% neutral19% psychosomatic
2020s
68% biomedical20% neutral11% psychosomatic

How the atlas works

Six principles that guide every entry.

Evidence-first

Every claim is anchored to a cited study. We show the evidence level so you can judge for yourself.

PEM-centered

Post-exertional malaise is the defining feature of ME/CFS. We flag whether each study accounts for it.

Uncertainty visible

We show what we don't know alongside what we do. Confidence labels and limitations are part of every entry.

Sources cited

Every study links to the original paper — DOI, PubMed, or journal — so you can verify everything.

Low-energy design

Quiet mode, readable summaries, and energy-rated entries so you can access the atlas at any capacity level.

Open knowledge

All atlas content is freely accessible. No paywalls, no registration, no dark patterns.

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