Imagine a condition that affects up to 2.5 million Americans but is not well understood or diagnosed¹. This is Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME) or Systemic Exertion Intolerance Disease (SEID). It can happen to anyone, even kids and teens, but mostly affects women in their 40s and 50s¹. Finding out why it happens and how to treat it is a big challenge for healthcare.

Key Takeaways

• Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME) or Systemic Exertion Intolerance Disease (SEID), is a debilitating condition affecting up to 2.5 million Americans.
• CFS can strike individuals of any age, including children and teenagers, though it is most common in women in their 40s and 50s.
• The causes of CFS are not fully understood, but may involve a combination of factors such as viral infections, weakened immune system, stress, and hormonal imbalances.
• Treatment for CFS focuses on managing symptoms and improving quality of life through medications, lifestyle changes, and alternative therapies.
• Advocacy groups are working to raise awareness and support individuals with CFS in obtaining a diagnosis and appropriate care.

The exact causes of CFS are still a mystery, but research points to viral infections, a weak immune system, stress, and hormonal issues¹. Some people might be more likely to get it because of their genes, as studies show problems in the immune system, energy production, and brain function¹. Viruses like Epstein-Barr, Lyme disease, and Q fever might also trigger CFS¹.

There’s no single test to diagnose CFS, but the National Academy of Medicine has guidelines for doctors¹. Sadly, up to 90% of cases might not be diagnosed, with about one in eight people thought to have it². Young adults and those assigned female at birth are more likely to get it, and it affects people of color more than white people².

Treating CFS aims to ease symptoms and improve life quality. There’s no cure yet, but a mix of medicines, lifestyle changes, and other therapies can help³. Antidepressants might help with anxiety and depression, but be careful as they can make other symptoms worse³. Researchers are also looking into treatments like Rituximab, a cancer drug that might help the immune system³.

Dealing with CFS is tough, but awareness, advocacy, and research are helping. People with this condition are finding more support and better ways to manage³. By understanding what causes it, its symptoms, and new treatments, doctors and patients can work together to lessen its effects and improve well-being.

What is Chronic Fatigue Syndrome?

Defining Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a condition that causes deep, lasting tiredness that doesn’t go away with rest⁴. It makes daily activities hard and lowers a person’s ability to do things they could do before they got sick⁴.

A Debilitating and Persistent Condition

ME/CFS lasts for years and can change in severity⁴. It includes symptoms like feeling worse after doing something, not sleeping well, and thinking problems⁴. These symptoms make it hard to keep a regular job or take care of oneself⁴.

Some people with ME/CFS can’t get out of bed or need a wheelchair, showing how much it affects daily life⁴. The unpredictable nature of the condition makes it even harder for those who have it.

Statistic	Source
The majority of individuals diagnosed with Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are women, with women being diagnosed much more often than men.	4
ME/CFS commonly affects young to middle-aged adults, though it can occur at any age.	4
People who have a family history of ME/CFS have a higher likelihood of developing the disorder, indicating a genetic component to the condition.	4
ME/CFS occurs up to two to four times more often in females than in males.	5
ME/CFS is uncommon before 10 years of age, and more often begins in adolescents and young adults.	5
Adolescents with ME/CFS are 3½ times more likely to have joints that have more flexibility (joint hypermobility).	5

In summary, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex and debilitating condition⁴. It causes ongoing tiredness, feeling worse after activity, and thinking problems⁴. This condition affects daily life a lot and is more common in women, young adults, and those with a family history⁴⁵.

Causes of Chronic Fatigue Syndrome

The exact cause of chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), is still unknown. But, research points to a mix of possible triggers and factors⁶.

Viral Infections and Genetic Predisposition

One theory is that viral infections might trigger CFS⁶. About 1 in 10 people who get infected with Epstein-Barr virus, Ross River virus, or Coxiella burnetti might later get a condition like ME/CFS⁶. This is more likely if they had severe symptoms during the infection⁶. Also, some people with COVID-19, or Long COVID, experience symptoms similar to ME/CFS⁶.

Studies in twins and families hint at a genetic link to CFS⁶. But, the exact genes or environmental factors causing it are still unknown⁶.

ME/CFS and autoimmune diseases like rheumatoid arthritis and fibromyalgia have similar signs of inflammation⁶. Women are more likely to get these conditions⁶. People with ME/CFS often say they had infections or stress before the illness started⁶.

They also might have lower levels of the hormone cortisol than healthy people⁶. This could play a part in the condition⁶.

People with ME/CFS often have issues with energy production⁶. This means they might not have enough energy for their brain and muscles⁶.

“The exact cause of chronic fatigue syndrome is still not fully understood, but it’s believed to be the result of a combination of factors, including viral infections, genetic predisposition, and problems with the immune system and hormonal imbalances.”

Chronic Fatigue Syndrome Symptoms

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), is a condition with many severe symptoms. It can greatly affect someone’s life⁷. The main symptom is feeling extremely tired that doesn’t get better with rest⁷.

People with CFS often have more symptoms, including:

• Post-exertional malaise (PEM): Symptoms get worse after doing even small tasks, making recovery slow⁷.
• Unrefreshing sleep: Feeling tired even after sleeping well⁷.
• Cognitive difficulties: Trouble with memory, focus, and processing information⁷.
• Muscle and joint pain: Different types and levels of pain⁷.
• Frequent headaches: Headaches are common in CFS patients⁷.
• Sore throat and tender lymph nodes: Many people with CFS experience these symptoms⁷.

How severe and which symptoms someone has can vary a lot. Symptoms can change over time⁷. Some may also have digestive issues, chills, night sweats, muscle weakness, shortness of breath, and irregular heartbeat⁷.

Orthostatic intolerance is another key symptom of CFS. It means symptoms get worse when standing up. This can cause dizziness, weakness, and blurry vision⁷.

“The debilitating symptoms of chronic fatigue syndrome can have a profound impact on an individual’s daily life and overall well-being.”

Knowing about the symptoms of CFS is key for diagnosing and treating it. This condition is complex and often not well understood⁷⁸⁹.

Diagnosis of Chronic Fatigue Syndrome

Diagnosing chronic fatigue syndrome (CFS) is complex because there’s no single test to confirm it¹⁰. Doctors must look at a patient’s health history, symptoms, and rule out other causes of fatigue¹⁰.

Diagnostic Criteria and Process

To get a diagnosis of CFS, a person must have severe, ongoing fatigue for at least 6 months that doesn’t get better with rest¹¹. They also need to have at least four symptoms like post-exertional malaise, poor sleep, thinking problems, and feeling bad when standing up¹¹.

¹⁰ Only about 20% of people with CFS get diagnosed¹⁰. The process includes a detailed medical check-up, physical exam, and lab tests to rule out other conditions¹⁰.

¹¹ ME/CFS often comes with health issues like sleep problems, irritable bowel syndrome, and fibromyalgia, which have similar symptoms¹¹. Doctors must think about these when diagnosing CFS.

¹² About one-third of people with ongoing fatigue might actually have CFS¹². This shows why a detailed check-up is key to correctly diagnose CFS and rule out other causes of fatigue.

¹² Women are twice as likely as men to have CFS, and it’s more common in people over 40¹². These facts help doctors in diagnosing CFS.

“Chronic Fatigue Syndrome is a debilitating and complex illness that can profoundly impact an individual’s daily life and overall well-being. Accurate diagnosis is crucial for effective management and support.”

By using the set criteria and a detailed check-up, doctors can help people with chronic fatigue syndrome get the right care and support¹²¹¹¹⁰.

Risk Factors for Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), is a complex condition. It can greatly affect someone’s daily life. The exact causes are not fully known, but some risk factors have been found that might make someone more likely to get it¹³.

Gender is a big risk factor for CFS. Women are about two to four times more likely to get it than men¹³¹⁴. People in their 40s and 50s also seem more at risk¹⁴.

Genetics also play a part in getting CFS. Research shows that differences in chromosomes and genes might affect who gets it¹³¹⁴. If someone has a family history of CFS, they might be more likely to get it too¹⁴.

Some viruses, like Epstein-Barr, Ross River, or Coxiella burnetti, can lead to CFS. About 10% of people who get these viruses might later develop ME/CFS¹³. Also, CFS patients often have more human herpesvirus (HHV)-6, which could be a clue to the cause¹⁴.

Other health issues, like fibromyalgia and postural orthostatic tachycardia syndrome (POTS), can up the risk of CFS¹³. Stress and traumatic events might also play a role in some cases¹³.

There’s also a hint that doctors might not always think of CFS in men, because it’s seen more in women¹³.

Understanding the risk factors for CFS is key. It helps in spotting and treating it early. This can make life better for those with Chronic Fatigue Syndrome¹⁴¹⁵.

Treating Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), is a complex condition with no single cure¹⁶. Yet, a mix of treatments can help manage symptoms and enhance life quality for those with CFS.

Symptom Management and Lifestyle Changes

Doctors may prescribe medicines for pain, sleep issues, or orthostatic intolerance¹⁶. It’s important to pace activities carefully to avoid worsening symptoms, which can last for days or weeks after exertion¹⁶. People with CFS have specific limits on activity levels, and certain tasks can trigger a relapse¹⁶.

Encouraging gentle, low-impact exercises is key, as intense workouts can make symptoms worse¹⁶. Good sleep habits are vital, and some may need sleep aids or a sleep specialist’s advice¹⁶. Managing pain with over-the-counter or prescription drugs is often necessary for those with CFS¹⁶.

Living with CFS can lead to depression, stress, and anxiety, and some find relief with antidepressants or mental health support¹⁶. Symptoms like dizziness can be helped with more fluids, salt, or medication¹⁶. Memory and focus issues are common, and some may benefit from stimulant drugs, though they can worsen symptoms for others¹⁶.

For those with chronic fatigue syndrome, a personalized approach to managing symptoms and lifestyle changes is crucial¹⁶. By working with healthcare providers, patients can find the best treatments for their unique needs and limitations¹⁶.

“There is no one-size-fits-all treatment for chronic fatigue syndrome. It’s a highly individualized condition that requires a tailored approach to symptom management and lifestyle adjustments.”

Managing CFS is a challenge, but a mix of medical care, lifestyle changes, and self-care can improve well-being and life quality¹⁶.

Medications for Chronic Fatigue Syndrome

There are no specific drugs for chronic fatigue syndrome (CFS), but doctors may suggest various medications to help manage symptoms¹⁷. These can include pain relievers, antidepressants, sleep aids, and treatments for orthostatic intolerance or autonomic nervous system issues¹⁸. The choice of medication depends on the person’s symptoms and needs, and may change over time.

Sleep issues are common in CFS, so some might use sleeping pills to get better sleep¹⁸. Stimulants, usually for ADHD, might be given to help with fatigue and brain function¹⁸. For chronic pain, stronger painkillers or specialist advice might be suggested¹⁸.

Drugs for dizziness or feeling lightheaded are also recommended for CFS symptoms related to orthostatic intolerance¹⁸. Since depression affects about half of CFS patients, antidepressants and counseling might be used to help with mental health¹⁸.

While these drugs can help with CFS symptoms, there’s no single cure¹⁷. Managing CFS often means working with a healthcare provider to find the best treatment plan for you.

Along with drugs, things like diet changes, herbal supplements, and mind-body practices might be tried to ease CFS symptoms¹⁹. But, the proof for these methods is not strong, so talk to your doctor before trying them¹⁷.

Dealing with CFS requires a full approach, with drugs being key in tackling its many symptoms¹⁷. By working with their healthcare team, people with CFS can find the right mix of medications to help them feel better and live better¹⁷¹⁸¹⁹.

Alternative Therapies for Chronic Fatigue Syndrome

Some people with chronic fatigue syndrome find relief in alternative or complementary therapies²⁰. These include acupuncture, massage, herbal remedies, dietary supplements, and mind-body practices like yoga, tai chi, and meditation²¹. Even though the proof of their effectiveness is not clear, some people say they feel better²⁰. Always talk to a healthcare provider before trying these treatments to make sure they’re safe and won’t interact with your medicines.

Acupuncture and Chinese patent drugs help with Chronic Fatigue Syndrome, studies show²⁰. Certain massages, like tui na, can ease depression, fatigue, pain, and insomnia²¹. Mindfulness-based stress reduction, which includes deep breathing and meditation, can lessen anxiety in ME/CFS patients²¹.

Cognitive behavioral therapy (CBT) might lessen symptoms and boost mood, stress, and anxiety in chronic fatigue syndrome, but its effectiveness is still being studied²¹. Graded exercise therapy can reduce ME/CFS symptoms and increase stamina if done carefully and tailored to the individual²¹. Some people with chronic fatigue syndrome get worse after exercising, so it’s important to have a personalized exercise plan²¹.

Studies suggest supplements like NADH, magnesium, and omega-3 fatty acids might help chronic fatigue syndrome patients, but only under a doctor’s watchful eye²¹. Some plant extracts, such as Angelica sinensis and Matricaria chamomilla, could ease menopausal symptoms like hot flashes²⁰.

• Catalpol showed benefits for brain function and protection against damage in a study by Zhang XL et al.²⁰
• Paeonia radix was looked into for its effects on serotonin and behavior in rodents, by Hong JA et al. and Xiao L et al.²⁰
• Sinapic acid was found to protect the brain and improve thinking in rodents, as shown by Karakida F et al.²⁰
• Polygala tenuifolia Willdenow extract, BT-11, was seen to boost thinking and protect the brain in rodent studies, according to Park CH et al.²⁰

The proof on whether these alternative therapies work is mixed, but some people with chronic fatigue syndrome say they feel better²⁰²¹. Always talk to a healthcare provider before trying these treatments to make sure they’re safe and won’t interact with your medicines.

Living with Chronic Fatigue Syndrome

Living with chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), is tough and can make you feel alone. It affects people in different ways. Some can still work or go to school with careful planning²². Others find it hard to keep a regular job and have to limit social and family life²². The most affected might need to use a wheelchair or stay in bed for a long time, needing help with everyday tasks like bathing or cooking²².

Coping Strategies and Support

Dealing with CFS means tackling both physical and emotional challenges. Doctors can help with some symptoms, but other strategies are key²². Seeing a therapist can help you cope with the illness and its effects on your life²². Occupational therapy can find ways to make work and daily tasks easier²².

Eating right is important for everyone, even those with chronic illnesses²². Think carefully before taking supplements because they can have both good and bad effects, especially if you’re on other medicines²². Trying things like meditation, gentle massage, deep breathing, or relaxation can also help²².

Getting support from family, friends, and groups can really help with CFS²³. Teaching others about your condition can make them understand and support you better²³. Using tools like day-planners, reminders on phones, and activities like puzzles can help with memory issues²³.

Keeping a positive attitude and speaking up for your needs is key to managing this illness. People’s stories about living with CFS show the big challenges and effects it has on daily life²²²³²⁴.

Chronic Fatigue Syndrome in Children

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is not just for adults²⁵. It can also hit children and teens, though it’s less common²⁵. To diagnose CFS in kids, they must be sick for at least 6 months²⁵. The symptoms in kids are a bit different from those in adults.

Kids with CFS might not feel the same muscle and joint pain as adults²⁵. They often say they have headaches, stomach pain, and other physical issues that are hard for them to express²⁵. CFS in kids can start after they get sick with something like the flu or mononucleosis²⁶. Feeling really tired after doing something can also be a sign²⁵.

To figure out if a child has CFS, doctors look at their health history, do physical checks, and mental health assessments²⁵. Doctors like neurologists, rheumatologists, or sleep experts help out²⁵. But, there’s no single test for CFS, so diagnosing it is hard²⁵.

Helping kids with CFS needs a team effort from doctors, teachers, and mental health experts²⁶. Getting better sleep, helping with thinking problems, and dealing with depression, stress, and anxiety are key²⁵. Even though it’s tough, most kids with CFS will get better over time, but it might take months or years²⁶.

If you think your child might have chronic fatigue syndrome, get them to see a doctor right away. The CDC and other trusted sources have lots of info and support for families dealing with this tough condition²⁵. With the right care and support, kids with CFS can learn to handle their symptoms and improve their life quality²⁵²⁷²⁶.

When to Seek Medical Attention

If you’re feeling tired all the time and it’s affecting your daily life, you should see a doctor²⁸. Fatigue can mean many things, but if it lasts a long time and doesn’t get better with rest, it might be chronic fatigue syndrome (CFS)²⁹. A doctor can check you out to see if you have CFS or something else.

Here are some signs you should visit a doctor for chronic fatigue:

• Fatigue that lasts for at least 6 months and is not relieved by rest²⁹
• Worsening of symptoms after physical or mental exertion (post-exertional malaise)²⁹
• Difficulties with concentrating, memory, or thinking clearly²⁹
• Unrefreshing sleep or problems with insomnia²⁹
• Muscle pain, joint pain, or headaches²⁹
• Tender lymph nodes or sore throat²⁹

CFS is more common in women than men²⁸³⁰, and it can happen to anyone, but mostly to those in their middle years³⁰. If you’re feeling this way, don’t wait to get help. A doctor can figure out what’s going on and help you get better.

Symptom	Description
Persistent Fatigue	Fatigue that lasts for at least 6 months and is not relieved by rest29
Post-Exertional Malaise	Worsening of symptoms after physical or mental exertion29
Cognitive Difficulties	Difficulties with concentrating, memory, or thinking clearly29
Sleep Disturbances	Unrefreshing sleep or problems with insomnia29
Physical Symptoms	Muscle pain, joint pain, headaches, tender lymph nodes, or sore throat29

If you’re showing these signs of chronic fatigue, it’s key to get medical help³⁰. Working with your doctor can really improve your life and health.

Chronic Fatigue Syndrome: Long-Term Outlook

Living with chronic fatigue syndrome (CFS) can be tough. Some people get better, but most don’t. Only about 5% fully recover³¹. Many have to adjust their lives to deal with ongoing symptoms.

CFS symptoms can change a lot over time³². In the U.S., around 3.3 million people have ME/CFS, but many haven’t been diagnosed³¹. The condition can be mild or severe, affecting daily life, work, and social life³¹.

Early diagnosis and good care might help some people recover, especially kids and teens³¹. For those with CFS, getting support from doctors is key. They help manage the unpredictable nature of the condition.

Functional Impact Levels of CFS	Description
Mild CFS	Able to perform light domestic tasks but may have difficulties with mobility; reduced leisure and social pursuits to manage work or education.
Moderate CFS	Experience restrictions in mobility and daily activities, often needing rest periods in the afternoon; poor quality sleep and disturbances.
Severe CFS	Unable to carry out activities for oneself, depend on minimal assistance for daily tasks; severe cognitive difficulties and potential wheelchair dependency.
Very Severe CFS	Bedridden and dependent on care for personal hygiene and eating, highly sensitive to sensory stimuli; some may require tube feeding.

Dealing with chronic fatigue syndrome is hard, but many find ways to cope and improve their lives³³. More research and understanding are key to helping those with CFS.

Resources and Support for Chronic Fatigue Syndrome

Living with chronic fatigue syndrome (CFS) can feel isolating, but there’s help out there. Many organizations offer support, information, and advocacy for those dealing with this condition³⁴. They help by educating people, connecting them with doctors, and building a community for those with CFS.

The Solve ME/CFS Initiative is a key group helping people with CFS, also known as myalgic encephalomyelitis (ME)³⁴. They provide educational materials, support for patients and caregivers, and work to raise awareness and fund research.

The Centers for Disease Control and Prevention (CDC) is a great resource for CFS info³⁴. Their website has details on symptoms, diagnosis, and how to manage the condition. It also links to support groups, both online and local, where people can share their experiences.

Local and regional support groups offer a sense of community for those with CFS³⁵. These groups provide emotional support, advice, and help finding healthcare providers and other resources.

CFS can make it hard to work or go to school because of the fatigue it causes³⁵. But, there are resources to help with disability claims and getting the right accommodations at work or school.

Managing CFS is tough, but these organizations and resources can be a big help³⁶. They offer the support, information, and advocacy needed to deal with this condition and improve health and well-being³⁴³⁵³⁶.

“Rest is crucial for individuals managing ME/CFS or Long Covid to reinstate physical equilibrium and manage symptoms effectively.”

State	Cumulative Cost to Jan 31, 2022	% of Population with Long Covid	% of Population with Disabling Long Covid	# of Individuals with Long Covid	# of Individuals with Disabling Long Covid
Indiana	$8.7B	7.3%	2.4%	481,100	160,000
Illinois	$16B	10%	4%	860,000	285,000
Idaho	$2B	6.7%	2.2%	113,000	37,500
Hawaii	$1.1B	4.4%	1.4%	62,000	20,500
Georgia	$12.6B	6.8%	2.3%	702,000	233,000
Florida	$30B	7.9%	2.6%	1,640,000	544,000

For those living with chronic fatigue syndrome, the right resources and support can greatly improve their lives³⁶. Connecting with these groups and networks gives patients the help they need to manage their condition and improve their health and well-being³⁴³⁵³⁶.

Conclusion

Chronic fatigue syndrome (ME/CFS) is a complex condition that affects many people³⁷. The exact causes are still unknown, but it might involve viral infections, immune system issues, and genetics³⁸. People with ME/CFS often feel constant fatigue, get worse after doing too much, have trouble thinking clearly, and struggle with their body’s automatic functions³⁸.

Diagnosing and treating ME/CFS is hard because it needs a detailed medical history and physical check-up³⁸. But, with the right mix of medicines, lifestyle changes, and other therapies, many people with ME/CFS can manage their symptoms better³⁷.

Looking ahead, the future for those with ME/CFS seems tough. But, new research and funding show more interest in this condition³⁷. As doctors find new ways to diagnose and treat it, people with ME/CFS should stay hopeful. They should also look for support and resources to help them live better.

FAQ

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID), is a complex disorder. It causes extreme fatigue that lasts over 6 months and doesn’t get better with rest.

What are the common symptoms of Chronic Fatigue Syndrome?

The main symptom is ongoing, severe fatigue that doesn’t improve with rest. Other symptoms include post-exertional malaise, unrefreshing sleep, and cognitive difficulties. People may also experience muscle and joint pain, frequent headaches, sore throat, and tender lymph nodes.

What causes Chronic Fatigue Syndrome?

The exact cause is still unknown. It’s thought to be caused by a mix of factors like viral infections, a weak immune system, stress, and hormonal imbalances.

How is Chronic Fatigue Syndrome diagnosed?

There’s no single test for it. Doctors must rule out other causes of fatigue and look for symptom patterns. The process includes a detailed medical history, physical exam, and various tests.

Who is at risk for developing Chronic Fatigue Syndrome?

Some people are more likely to get it. These include women, people in their 40-50s, those with a family history, and those who’ve had certain viral infections or medical conditions.

How is Chronic Fatigue Syndrome treated?

There’s no single cure. Treatment involves a mix of medications, lifestyle changes, and alternative therapies to help manage symptoms and improve life quality.

Can Chronic Fatigue Syndrome affect children and adolescents?

Yes, it can happen in kids and teens too, though it’s less common. Symptoms are similar to those in adults. It’s important to work closely with healthcare and education professionals to support them.

When should someone seek medical attention for persistent fatigue?

If you have ongoing, unexplained fatigue that affects your daily life, see a doctor. Long-lasting fatigue without rest improvement could be chronic fatigue syndrome.

What is the long-term outlook for people with Chronic Fatigue Syndrome?

Outcomes vary widely. Some may see improvement or remission, but only about 5% fully recover. Many learn to manage it as a chronic illness with ongoing support from healthcare providers.

Where can I find resources and support for Chronic Fatigue Syndrome?

Many organizations offer information, support, and advocacy for those with CFS. Look for the Solve ME/CFS Initiative, the Centers for Disease Control and Prevention (CDC), and local or online support groups.

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31. Clinical Overview of ME/CFS – https://www.cdc.gov/me-cfs/hcp/clinical-overview/index.html
32. Chronic fatigue syndrome – https://patient.info/signs-symptoms/tiredness-fatigue/chronic-fatigue-syndrome-myalgic-encephalomyelitis
33. Myalgic encephalomyelitis/chronic fatigue syndrome – https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome
34. Home – Solve ME/CFS Initiative – https://solvecfs.org/
35. Patient and Caregiver Resources – Solve ME/CFS Initiative – https://solvecfs.org/me-cfs-long-covid/patient-and-caregiver-resources/
36. Resources – https://mecfscliniciancoalition.org/resources/
37. Chronic Fatigue Syndrome research – Naviaux Lab – https://naviauxlab.ucsd.edu/science-item/chronic-fatigue-syndrome-research/
38. Recommendations – Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – https://www.ncbi.nlm.nih.gov/books/NBK284910/