Percentage of patients reporting a symptom indicative of central sensitivity on at least a weekly basis as a function of having an FMS or ME/CFS diagnosis.
Symptom
FMS(n = 1,127*)
ME/CFS(n = 619*)
Fatigue for no reason
97.1
97.3
Fatigue increases the day after you are active
95.7
97.3
Pain in arms and legs that is not due to hard exercise
94.9
84.0
Pain increases the day after you are active
94.9
90.2
Pain moving from one part of the body to another on different days
Source: Data from an online survey of FMS and ME/CFS patient support groups [31]. *: of whom 365 patients reported a diagnosis of FMS and ME/CFS. FMS: fibromyalgia syndrome; ME/CFS: myalgic encephalomyelitis/chronic fatigue syndrome.
Declarations
Author contributions
MEH: Conceptualization, Visualization, Writing—original draft, Writing—review & editing. The author read and approved the submitted version.
Conflicts of interest
The author declares that he has no conflicts of interest.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Wolfe F, Walitt B, Perrot S, Rasker JJ, Häuser W. Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias.PLoS One. 2018;13:e0203755. [DOI] [PubMed] [PMC]
Johnston S, Brenu EW, Staines D, Marshall-Gradisnik S. The prevalence of chronic fatigue syndrome/ myalgic encephalomyelitis: a meta-analysis.Clin Epidemiol. 2013;5:105–10. [DOI] [PubMed] [PMC]
Boomershine CS. Fibromyalgia: the prototypical central sensitivity syndrome.Curr Rheumatol Rev. 2015;11:131–45. [DOI] [PubMed]
Borda-Mas M, Chamorro-Moriana G, Almeda N, Ridao-Fernandez C, Sánchez-Fernández M. Assessment of Central Sensitivity Syndrome and Sensory Processing Sensitivity: A Systematic Review.Ann N Y Acad Sci. 2026;1556:e70201. [DOI] [PubMed] [PMC]
Goldenberg DL. The pivotal role of central sensitization in long COVID, fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome.Expert Rev Neurother. 2025;25:973–89. [DOI] [PubMed]
Yunus MB. Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness.Semin Arthritis Rheum. 2008;37:339–52. [DOI] [PubMed]
Agarwal A, Oparin Y, Glick L, Fitzcharles M, Adachi JD, Cooper MD, et al. Attitudes Toward and Management of Fibromyalgia: A National Survey of Canadian Rheumatologists and Critical Appraisal of Guidelines.J Clin Rheumatol. 2018;24:243–9. [DOI] [PubMed]
Agarwal A, Emary PC, Gallo L, Oparin Y, Shin SH, Fitzcharles M, et al. Physicians’ knowledge, attitudes, and practices regarding fibromyalgia: A systematic review and meta-analysis of cross-sectional studies.Medicine (Baltimore). 2024;103:e39109. [DOI] [PubMed] [PMC]
Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future.J Pain. 2015;16:807–13. [DOI] [PubMed]
Walitt B, Fitzcharles M, Hassett AL, Katz RS, Häuser W, Wolfe F. The longitudinal outcome of fibromyalgia: a study of 1555 patients.J Rheumatol. 2011;38:2238–46. [DOI] [PubMed]
Straus SE. History of chronic fatigue syndrome.Rev Infect Dis. 1991;13 Suppl 1:S2–7. [DOI] [PubMed]
Friedberg F. Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?Fatigue: Biomed Health Behav. 2016;4:127–31. [DOI]
Marks DF. The Rise and Fall of the Psychosomatic Approach to Medically Unexplained Symptoms, Myalgic Encephalomyelitis and Chronic Fatigue Syndrome.AEPHR. 2022;1:97–143. [DOI]
Marks DF. Treatment Harms To Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.Qeios xug3pt.2 [Preprint]. 2023 [cited 2025 Nov 8]. Available from: https://www.qeios.com/read/XUG3PT.2
Bermpohl FMG, Kucharczyk-Bodenburg A, Martin A. Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis.Int J Behav Med. 2024;31:895–910. [DOI] [PubMed] [PMC]
Tack M. A high drop-out rate of cognitive behavioural therapy for chronic fatigue.J R Soc Med. 2021;114:284. [DOI] [PubMed] [PMC]
Baker R, Shaw EJ. Diagnosis and management of chronic fatigue syndrome or myalgic encephalomyelitis (or encephalopathy): summary of NICE guidance.BMJ. 2007;335:446–8. [DOI] [PubMed] [PMC]
Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. London: National Institute for Health and Care Excellence (NICE); 2021. [PubMed]
Flottorp SA, Brurberg KG, Fink P, Knoop H, Wyller VBB. New NICE guideline on chronic fatigue syndrome: more ideology than science?Lancet. 2022;399:611–3. [DOI] [PubMed]
Barry PW, Kelley K, Tan T, Finlay I. NICE guideline on ME/CFS: robust advice based on a thorough review of the evidence.J Neurol Neurosurg Psychiatry. 2024;95:671–4. [DOI] [PubMed]
Thoma M, Froehlich L, Hattesohl DBR, Quante S, Jason LA, Scheibenbogen C. Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients.Medicina (Kaunas). 2023;60:83. [DOI] [PubMed] [PMC]
Miller A, Symington F, Garner P, Pedersen M. Patients with severe ME/CFS need hope and expert multidisciplinary care.BMJ. 2025;389:r977. [DOI] [PubMed]
van der Werf SP, de Vree B, Alberts M, van der Meer JW, Bleijenberg G; Netherlands Fatigue Research Group Nijmegen. Natural course and predicting self-reported improvement in patients with chronic fatigue syndrome with a relatively short illness duration.J Psychosom Res. 2002;53:749–53. [DOI] [PubMed]
Stone J, Wojcik W, Durrance D, Carson A, Lewis S, MacKenzie L, et al. What should we say to patients with symptoms unexplained by disease? The “number needed to offend”.BMJ. 2002;325:1449–50. [DOI] [PubMed] [PMC]
Klem N, Slater H, Rowbotham S, Chua J, Waller R, Stinson JN, et al. Lived and care experiences of young people with chronic musculoskeletal pain and mental health conditions: a systematic review with qualitative evidence synthesis.Pain. 2025;166:732–54. [DOI] [PubMed] [PMC]
Lacerda EM, McDermott C, Kingdon CC, Butterworth J, Cliff JM, Nacul L. Hope, disappointment and perseverance: Reflections of people with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Multiple Sclerosis participating in biomedical research. A qualitative focus group study.Health Expect. 2019;22:373–84. [DOI] [PubMed] [PMC]
Kuhn TS. The structure of scientific revolutions. Chicago: University of Chicago press; 1997.
Bari AD, Demo G, Patron E. Unravelling the relationship between anxiety, autonomic nervous system dysfunction and fibromyalgia: a systematic review.Clin Exp Rheumatol. 2025;43:1136–45. [DOI] [PubMed]
Novak P, Systrom DM, Witte A, Marciano SP, Felsenstein D, Milunsky JM, et al. Shared autonomic phenotype of long COVID and myalgic encephalomyelitis/chronic fatigue syndrome.PLoS One. 2026;21:e0341278. [DOI] [PubMed] [PMC]
Lacourt T, Houtveen J, van Doornen L. “Functional somatic syndromes, one or many?” An answer by cluster analysis.J Psychosom Res. 2013;74:6–11. [DOI] [PubMed]
Hyland ME, Bacon AM, Lanario JW, Davies AF. Symptom frequency and development of a generic functional disorder symptom scale suitable for use in studies of patients with irritable bowel syndrome, fibromyalgia syndrome or chronic fatigue syndrome.Chronic Dis Transl Med. 2019;5:129–38. [DOI] [PubMed] [PMC]
McDermid AJ, Rollman GB, McCain GA. Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification.Pain. 1996;66:133–44. [DOI] [PubMed]
Crombez G, Eccleston C, Van den Broeck A, Goubert L, Van Houdenhove B. Hypervigilance to pain in fibromyalgia: the mediating role of pain intensity and catastrophic thinking about pain.Clin J Pain. 2004;20:98–102. [DOI] [PubMed]
Uhde M, Indart AC, Green PHR, Yolken RH, Cook DB, Shukla SK, et al. Suppressed immune and metabolic responses to intestinal damage-associated microbial translocation in myalgic encephalomyelitis/chronic fatigue syndrome.Brain Behav Immun Health. 2023;30:100627. [DOI] [PubMed] [PMC]
Malkova AM, Shoenfeld Y. Autoimmune autonomic nervous system imbalance and conditions: Chronic fatigue syndrome, fibromyalgia, silicone breast implants, COVID and post-COVID syndrome, sick building syndrome, post-orthostatic tachycardia syndrome, autoimmune diseases and autoimmune/inflammatory syndrome induced by adjuvants.Autoimmun Rev. 2023;22:103230. [DOI] [PubMed]
Hanson MR. The viral origin of myalgic encephalomyelitis/chronic fatigue syndrome.PLoS Pathog. 2023;19:e1011523. [DOI] [PubMed] [PMC]
Butler S, Chalder T, Ron M, Wessely S. Cognitive behaviour therapy in chronic fatigue syndrome.J Neurol Neurosurg Psychiatry. 1991;54:153–8. [DOI] [PubMed] [PMC]
Surawy C, Hackmann A, Hawton K, Sharpe M. Chronic fatigue syndrome: a cognitive approach.Behav Res Ther. 1995;33:535–44. [DOI] [PubMed]
Wampold BE, Imel ZE. The great psychotherapy debate: The evidence for what makes psychotherapy work. Routledge; 2015.
Besharat MA, Behpajooh A, Poursharifi H, Zarani F. Personality and chronic fatigue syndrome: The role of the five-factor model.Asian J Psychiatr. 2011;4:55–9. [DOI] [PubMed]
Malin K, Littlejohn GO. Personality and fibromyalgia syndrome.Open Rheumatol J. 2012;6:273–85. [DOI] [PubMed] [PMC]
Asgarabad MH, Yegaei PS, Jafari F, Azami-Aghdash S, Lumley MA. The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis.Eur J Pain. 2023;27:321–37. [DOI] [PubMed]
Maroti D, Molander P, Bileviciute-Ljungar I. Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome.Scand J Psychol. 2017;58:52–61. [DOI] [PubMed]
van de Putte EM, Engelbert RHH, Kuis W, Kimpen JLL, Uiterwaal CSPM. Alexithymia in adolescents with chronic fatigue syndrome.J Psychosom Res. 2007;63:377–80. [DOI] [PubMed]
Bieling PJ, Israeli AL, Antony MM. Is perfectionism good, bad, or both? Examining models of the perfectionism construct.Personal Individ Differ. 2004;36:1373–85. [DOI]
Flett GL, Hewitt PL. Perfectionism: Theory, research, and treatment. American Psychological Association; 2002.
Sirois FM, Toussaint L, Hirsch JK, Kohls N, Weber A, Offenbächer M. Trying to be perfect in an imperfect world: A person-centred test of perfectionism and health in fibromyalgia patients versus healthy controls.Personal Individ Differ. 2019;137:27–32. [DOI]
Maes F, Vanaerschot G, Goossens E, Van Houdenhove B. Fibromyalgia, perfectionism, and interpersonal style. Further evidence for a person-centered approach.J Pain Res Manag. 2024;1:11–8. [DOI]
Sirois FM, Toussaint L, Hirsch JK, Kohls N, Offenbächer M. A person-centred test of multidimensional perfectionism and health in people with chronic fatigue syndrome versus healthy controls.Personal Individ Differ. 2021;181:111036. [DOI]
Bacon AM, White L. The association between adverse childhood experiences, self-silencing behaviours and symptoms in women with fibromyalgia.Psychol Health Med. 2022;28:2073–83. [DOI] [PubMed]
Hambrook D, Oldershaw A, Rimes K, Schmidt U, Tchanturia K, Treasure J, et al. Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome.Br J Clin Psychol. 2011;50:310–25. [DOI] [PubMed]
Nojima N. Difficulties of living with an illness not considered a “disease”: Focusing on the illness behavior of myalgic encephalomyelitis/chronic fatigue syndrome patients.Osaka Hum Sci. 2020;6:91–106. [DOI]
Paxman CG. “Everyone thinks I am just lazy”: Legitimacy narratives of Americans suffering from fibromyalgia.Health (London). 2021;25:121–37. [DOI] [PubMed]
Leone SS, Wessely S, Huibers MJH, Knottnerus JA, Kant I. Two sides of the same coin? On the history and phenomenology of chronic fatigue and burnout.Psychol Health. 2011;26:449–64. [DOI] [PubMed]
Van Houdenhove B, Neerinckx E, Onghena P, Lysens R, Vertommen H. Premorbid “overactive” lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship?J Psychosom Res. 2001;51:571–6. [DOI] [PubMed]
Hyland M. A history of psychology in ten questions: Lessons for modern life. Routledge; 2023.
Fodor JA. Psychological explanation: An introduction to the philosophy of psychology. Random House Inc; 1968.
Iwasaki H, Okuyama A, editors. Development of a Reference Signal Self-Organizing Control System Based on Deep Reinforcement Learning. 2021 IEEE International Conference on Mechatronics (ICM); 2021 Mar 7–9; Kashiwa, Japan. 2021. [DOI]
Beisenbi M, Abdiramanov O, Beisenbina S, Omirzak I, Alibek A. A self-organizing control system for deterministic chaotic modes of a nonlinear spacecraft in the class of two-parameter structurally stable maps.Crisis. 2025;1:2.
Rakhmetov M, Adiyeva A, Orazbayeva B, Yelezhanova S, Tuleuova R, Moldasheva R. Solving the Synthesis Problem Self-Organizing Control System in the Class of Elliptical Accidents Optics for Objects with One Input and One Output.Computation. 2026;14:21. [DOI]
Hyland ME. The origins of health and disease. Cambridge University Press; 2011.
Marks DF. Myalgic encephalomyelitis/chronic fatigue syndrome as a breakdown of homeostasis.Qeios FZ1Y68.3 [Preprint]. 2022 [cited 2025 May 10]. Available from: https://www.qeios.com/read/FZ1Y68.3
Kahneman D. Thinking, fast and slow. Macmillan; 2011. [DOI]
Pennebaker JW. The Psychology of Physical Symptoms. Springer-Verlag; 1982. [DOI]
Hyland ME. Control theory interpretation of psychological mechanisms of depression: comparison and integration of several theories.Psychol Bull. 1987;102:109–21. [PubMed]
Powers WT. Quantitative analysis of purposive systems: Some spadework at the foundations of scientific psychology.Psychol Rev. 1978;85:417–35. [DOI]
Melidis C, Denham SL, Hyland ME. A test of the adaptive network explanation of functional disorders using a machine learning analysis of symptoms.Biosystems. 2018;165:22–30. [DOI] [PubMed]
Hyland ME, Antonacci Y, Bacon AM. Comparison of the symptom networks of long-COVID and chronic fatigue syndrome: From modularity to connectionism.Scand J Psychol. 2024;65:1132–40. [DOI] [PubMed]
Wrzus C, Luong G, Wagner GG, Riediger M. Longitudinal coupling of momentary stress reactivity and trait neuroticism: Specificity of states, traits, and age period.J Pers Soc Psychol. 2021;121:691–706. [DOI] [PubMed] [PMC]
Beiner E, Hermes M, Reichert J, Kleinke K, Vock S, Löffler A, et al. Perceived and endocrine acute and chronic stress indicators in fibromyalgia syndrome.Sci Rep. 2024;14:30471. [DOI] [PubMed] [PMC]
Bjørklund G, Dadar M, Pivina L, Doşa MD, Semenova Y, Maes M. Environmental, Neuro-immune, and Neuro-oxidative Stress Interactions in Chronic Fatigue Syndrome.Mol Neurobiol. 2020;57:4598–607. [DOI] [PubMed]
Ovrom EA, Mostert KA, Khakhkhar S, McKee DP, Yang P, Her YF. A Comprehensive Review of the Genetic and Epigenetic Contributions to the Development of Fibromyalgia.Biomedicines. 2023;11:1119. [DOI] [PubMed] [PMC]
Liu PZ, Raizen DM, Skarke C, Brooks TG, Anafi RC. Genetic variants associated with chronic fatigue syndrome predict population-level fatigue severity and actigraphic measurements.Sleep. 2025;48:zsae243. [DOI] [PubMed] [PMC]
Alsiri N, Alhadhoud M, Alkatefi T, Palmer S. The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review.Semin Arthritis Rheum. 2023;58:152127. [DOI] [PubMed]
Duffield SJ, Miller N, Zhao S, Goodson NJ. Concomitant fibromyalgia complicating chronic inflammatory arthritis: a systematic review and meta-analysis.Rheumatology (Oxford). 2018;57:1453–60. [DOI] [PubMed] [PMC]
D’Onghia M, Ursini F, Cinotti E, Calabrese L, Tognetti L, Cartocci A, et al. Psoriasis and Fibromyalgia: A Systematic Review.J Pers Med. 2024;14:165. [DOI] [PubMed] [PMC]
Lambregts BIHM, Vassena E, Jansen A, Stremmelaar DE, Pickkers P, Kox M, et al. Fatigue during acute systemic inflammation is associated with reduced mental effort expenditure while task accuracy is preserved.Brain Behav Immun. 2023;112:235–45. [DOI] [PubMed]
Bieńkowski K, Bielaska A, Wesołek-Bielaska E, Kołodziej W, Gałązka JK, Greszta M. Chronic fatigue syndrome related to herpes simplex viruses infection – a narrative review.Qual Sport. 2024;17:52946. [DOI]
Mozhgani S, Rajabi F, Qurbani M, Erfani Y, Yaslianifard S, Moosavi A, et al. Human Herpesvirus 6 Infection and Risk of Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis.Intervirology. 2022;65:49–57. [DOI] [PubMed] [PMC]
Ruiz-Pablos M, Paiva B, Montero-Mateo R, Garcia N, Zabaleta A. Epstein-Barr Virus and the Origin of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome.Front Immunol. 2021;12:656797. [DOI] [PubMed] [PMC]
Hickie I, Davenport T, Wakefield D, Vollmer-Conna U, Cameron B, Vernon SD, et al.; Dubbo Infection Outcomes Study Group. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study.BMJ. 2006;333:575. [DOI] [PubMed] [PMC]
Hsu H, Chang H, Lin C, Yao W, Hung C, Pang S, et al. Increased risk of chronic fatigue syndrome following pneumonia: A population-based Cohort study.J Infect Public Health. 2024;17:102495. [DOI] [PubMed]
Ceban F, Ling S, Lui LMW, Lee Y, Gill H, Teopiz KM, et al. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis.Brain Behav Immun. 2022;101:93–135. [DOI] [PubMed] [PMC]
Chang H, Kuo C, Yu T, Ke L, Hung C, Tsai S. Increased risk of chronic fatigue syndrome following infection: a 17-year population-based cohort study.J Transl Med. 2023;21:804. [DOI] [PubMed] [PMC]
Magnus P, Gunnes N, Tveito K, Bakken IJ, Ghaderi S, Stoltenberg C, et al. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine.Vaccine. 2015;33:6173–7. [DOI] [PubMed]
Simko LC, Espinoza LF, McMullen K, Herndon DN, Suman O, Fauerbach JA, et al. Fatigue Following Burn Injury: A Burn Model System National Database Study.J Burn Care Res. 2018;39:450–6. [DOI] [PubMed] [PMC]
Tsai S, Lin C, Shih S, Hsu C, Leong K, Kuo C, et al. Increased risk of chronic fatigue syndrome following burn injuries.J Transl Med. 2018;16:342. [DOI] [PubMed] [PMC]
Konuk S, Ozel A, Ozsari E, Nasircilar A. Prevalence of fibromyalgia in asthma and its impact on asthma control: a case-control study.Ann Med. 2025;57:2566392. [DOI] [PubMed] [PMC]
Günaydın FE, Ediger D, Erbay M. Fatigue: A forgotten symptom of asthma.Clin Respir J. 2021;15:741–52. [DOI] [PubMed]
Hyland ME, Lanario JW, Wei Y, Jones RC, Masoli M. Evidence for similarity in symptoms and mechanism: The extra-pulmonary symptoms of severe asthma and the polysymptomatic presentation of fibromyalgia.Immun Inflamm Dis. 2019;7:239–49. [DOI] [PubMed] [PMC]
Kasl SV, Evans AS, Niederman JC. Psychosocial risk factors in the developmental of infectious mononucleosis.Psychosom Med. 1979;41:445–66. [DOI] [PubMed]
Moss-Morris R, Spence MJ, Hou R. The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map?Psychol Med. 2011;41:1099–107. [DOI] [PubMed]
Belavy DL, Van Oosterwijck J, Clarkson M, Dhondt E, Mundell NL, Miller CT, et al. Pain sensitivity is reduced by exercise training: Evidence from a systematic review and meta-analysis.Neurosci Biobehav Rev. 2021;120:100–8. [DOI] [PubMed]
Årnes AP, Nielsen CS, Stubhaug A, Fjeld MK, Johansen A, Morseth B, et al. Longitudinal relationships between habitual physical activity and pain tolerance in the general population.PLoS One. 2023;18:e0285041. [DOI] [PubMed] [PMC]
Apter MJ. Reversal theory and personality: A review.J Res Personal. 1984;18:265–88. [DOI]
Zeaman D, House BJ. The growth and decay of reactive inhibition as measured by alternation behavior.J Exp Psychol. 1951;41:177–86. [DOI] [PubMed]
Dorczok MC, Mittmann G, Mossaheb N, Schrank B, Bartova L, Neumann M, et al. Dietary Supplementation for Fatigue Symptoms in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)-A Systematic Review.Nutrients. 2025;17:475. [DOI] [PubMed] [PMC]
Echeverria-Villalobos M, Tortorici V, Brito BE, Ryskamp D, Uribe A, Weaver T. The role of neuroinflammation in the transition of acute to chronic pain and the opioid-induced hyperalgesia and tolerance.Front Pharmacol. 2023;14:1297931. [DOI] [PubMed] [PMC]
Barhorst EE, Boruch AE, Cook DB, Lindheimer JB. Pain-Related Post-Exertional Malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: A Systematic Review and Three-Level Meta-Analysis.Pain Med. 2022;23:1144–57. [DOI] [PubMed]
Paul L, Wood L, Behan WM, Maclaren WM. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome.Eur J Neurol. 1999;6:63–9. [DOI] [PubMed]
VanNess JM, Stevens SR, Bateman L, Stiles TL, Snell CR. Postexertional malaise in women with chronic fatigue syndrome.J Womens Health (Larchmt). 2010;19:239–44. [DOI] [PubMed]
White PD, Goldsmith K, Johnson AL, Chalder T, Sharpe M. Recovery from chronic fatigue syndrome after treatments given in the PACE trial.Psychol Med. 2013;43:2227–35. [DOI] [PubMed] [PMC]
Sanal-Hayes NE, Mclaughlin M, Mair JL, Ormerod J, Carless D, Meach R, et al. ‘Pacing’ for management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a systematic review and meta-analysis.Fatigue: Biomed Health Behav. 2024;13:36–53. [DOI]
Casson S, Jones MD, Cassar J, Kwai N, Lloyd AR, Barry BK, et al. The effectiveness of activity pacing interventions for people with chronic fatigue syndrome: a systematic review and meta-analysis.Disabil Rehabil. 2023;45:3788–802. [DOI] [PubMed]
Abresch A, Brownell D, Hoyle N, Shrinzada S, Yumul F. Does tai chi improve fibromyalgia symptoms more than aerobic exercise?EBPR. 2024;27:11–2. [DOI]
Wang C, Schmid CH, Fielding RA, Harvey WF, Reid KF, Price LL, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.BMJ. 2018;360:k851. [DOI] [PubMed] [PMC]
Cheshire A, Ridge D, Clark L, White P. Guided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions.Disabil Rehabil. 2020;42:368–77. [DOI] [PubMed]
Hyland ME, Whalley B. Motivational concordance: an important mechanism in self-help therapeutic rituals involving inert (placebo) substances.J Psychosom Res. 2008;65:405–13. [DOI] [PubMed]
Hyland ME. Motivation and placebos: do different mechanisms occur in different contexts?Philos Trans R Soc Lond B Biol Sci. 2011;366:1828–37. [DOI] [PubMed] [PMC]
Assefi N, Bogart A, Goldberg J, Buchwald D. Reiki for the treatment of fibromyalgia: a randomized controlled trial.J Altern Complement Med. 2008;14:1115–22. [DOI] [PubMed] [PMC]
Gökdere Çinar H, Alpar Ş, Ilhan S. Evaluation of the Impacts of Reiki Touch Therapy on Patients Diagnosed With Fibromyalgia Who Are Followed in the Pain Clinic.Holist Nurs Pract. 2022;37:161–71. [DOI] [PubMed]
Skelly M, Walker H. Alternative Treatments for Fibromyalgia and Chronic Fatigue Syndrome. Turner Publishing Company; 2006.
Kim K, Chung W, Song M, Chung S. Complementary and alternative medicine treatments in the management of chronic fatigue syndrome: a systematic review of randomized controlled trials.Orient Pharm Exp Med. 2012;13:85–93. [DOI]
Walach H, Bosch H, Lewith G, Naumann J, Schwarzer B, Falk S, et al. Effectiveness of distant healing for patients with chronic fatigue syndrome: a randomised controlled partially blinded trial (EUHEALS).Psychother Psychosom. 2008;77:158–66. [DOI] [PubMed]
Li J, Piao F, Zeng Q, Yan H, Bi Y, Zhang S, et al. The effect of massage on patients with chronic fatigue syndrome: A systematic review and meta-analysis.Medicine (Baltimore). 2024;103:e37973. [DOI] [PubMed] [PMC]
Ughreja RA, Venkatesan P, Gopalakrishna DB, Singh YP, Lakshmi RV. Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: A randomized controlled trial.J Integr Med. 2024;22:473–83. [DOI] [PubMed]
Lee K, Lewis GN. Short term relief of multisite chronicpain with Bowen Therapy: A double-blind, randomized controlled trial.J Bodyw Mov Ther. 2020;24:271–9. [DOI] [PubMed]
Kong L, Ren J, Fang S, Li Y, Wu Z, Zhou X, et al. Effects of traditional Chinese mind-body exercises for patients with chronic fatigue syndrome: A systematic review and meta-analysis.J Glob Health. 2023;13:04157. [DOI] [PubMed] [PMC]
Brea-Gómez B, Pérez-Gisbert L, Fernández-Castro I, Valenza MC, Torres-Sánchez I. Effects of Virtual Reality-Based Rehabilitation in the Treatment of Patients with Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Games Health J. 2025;14:79–102. [DOI] [PubMed]
Whalley B, Hyland ME. One size does not fit all: motivational predictors of contextual benefits of therapy.Psychol Psychother. 2009;82:291–303. [DOI] [PubMed]
Davies AF, Hill P, Fay D, Dee A, Locher C. Body Reprogramming: Reframing the Fibromyalgia narrative and providing an integrative therapeutic model.Health Psychol Open. 2020;7:2055102920971494. [DOI] [PubMed] [PMC]
Hyland ME. A new paradigm to explain functional disorders and the adaptive network theory of chronic fatigue syndrome and fibromyalgia syndrome.In: Resistance and renewal in theoretical psychology. Captus University Publications; 2017. pp. 21–31.
Hyland ME, Hinton C, Hill C, Whalley B, Jones RC, Davies AF. Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence based interventions.Br J Pain. 2016;10:156–61. [DOI] [PubMed] [PMC]
Locher C, Kharko A, Lanario JW, Druart L, Hansford K, Koechlin H, et al. Has anything changed for Fibromyalgia? Focus groups with patients on their lived experiences in England.PLoS One. 2026;21:e0342065. [DOI] [PubMed] [PMC]
Lanario JW, Hudson E, Locher C, Dee A, Elliot K, Davies AF. Body reprogramming for fibromyalgia and central sensitivity syndrome: A preliminary evaluation.SAGE Open Med. 2023;11:20503121231207207. [DOI] [PubMed] [PMC]
Chen P. Asking Better Questions: Strategic Questioning as a Psychologically Wise Intervention.Perspect Psychol Sci. 2026;21:80–95. [DOI] [PubMed] [PMC]
Lemieux I. Reversing Type 2 Diabetes: The Time for Lifestyle Medicine Has Come!Nutrients. 2020;12:1974. [DOI] [PubMed] [PMC]