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Appointment Hotline: (214) 390-7557
By Dr. Robert Groysman, MD | Board-Certified Pain Medicine & Anesthesiology
Chronic fatigue syndrome (ME/CFS) goes far beyond feeling tired — it’s a complex, long-term condition that can make even daily tasks exhausting. ME/CFS is a debilitating disease that affects millions of people in the United States and often shares striking similarities with long COVID symptoms. At Covid Institute in Plano, Dr. Robert Groysman and team help patients across Dallas–Fort Worth with thorough evaluation and advanced treatment options designed to support recovery and quality of life.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious and often long-lasting illness that keeps people from doing their usual activities. It makes physical and mental exertion difficult. Symptoms include trouble thinking, severe tiredness and other symptoms. The condition is recognized by the CDC and represents a genuine biological illness, not a psychological disorder.
In 2015, the Institute of Medicine published diagnostic criteria for ME/CFS in adults and children. The criteria state that three required symptoms and at least one of two additional symptoms are required for diagnosis. What distinguishes ME/CFS from ordinary fatigue is its severity and the hallmark symptom of post-exertional malaise (PEM) — a worsening of symptoms following even minimal physical or mental activity.
The condition affects people of all ages, though it’s most common in middle-aged adults. Women are diagnosed with ME/CFS about 1.5 to four times more often than men. Many patients develop ME/CFS following viral infections, including COVID-19, Epstein-Barr virus, or other pathogens.
ME/CFS symptoms are wide-ranging and can significantly impact every aspect of daily life.
Core Symptoms:
Additional Symptoms:
These symptoms often overlap with conditions like POTS, fibromyalgia, and particularly long COVID, making accurate diagnosis crucial for effective treatment.
There is no confirmatory test currently available to diagnose ME/CFS. However, people with ME/CFS often are found to have biological abnormalities.
Yet none of these “biomarkers” have sufficient sensitivity and specificity to constitute a diagnostic test.
Diagnosis relies on clinical assessment using established criteria, most commonly the 2015 Institute of Medicine (IOM) criteria. Dr. Groysman follows a comprehensive diagnostic approach:
Clinical Evaluation:
Diagnostic Criteria Requirements:
The “chronic fatigue test” often mentioned online refers to this systematic clinical evaluation combined with laboratory work to exclude other fatiguing conditions like anemia, hypothyroidism, or sleep disorders.
There is no cure or approved treatment for myalgic encephalomyelitis/chronic fatigue syndrome. However, some symptoms can be treated or managed.
Treatment focuses on symptom management, activity pacing, and addressing underlying dysfunction.
Standard Management Approaches
Activity Pacing: PEM can be addressed by activity management, also called pacing. The goal of pacing is to learn to balance activity and rest to avoid PEM flare-ups. This involves staying within energy limits to prevent symptom crashes.
Sleep Optimization: Establishing consistent sleep hygiene, addressing sleep disorders, and sometimes using targeted medications for sleep improvement.
Nutritional Support: Addressing nutrient deficiencies, supporting mitochondrial function, and managing gut dysbiosis that often accompanies ME/CFS.
Dr. Groysman offers innovative interventions targeting the underlying mechanisms of ME/CFS:
Stellate Ganglion Block (SGB): Our previous work has shown that modulating the autonomic nervous system can alleviate symptoms of Long COVID, which shares striking similarities with ME/CFS and stellate ganglion blocks significantly helped patients with Long Covid and ME/CFS. This targeted injection helps restore autonomic nervous system balance. Learn more about SGB treatment.
Epipharyngeal Abrasive Therapy (EAT): EAT reduced inflammation in the epipharynx and significantly improved the intensity of fatigue, headache, and attention disorder, which may be related to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This emerging therapy addresses persistent inflammation in the upper respiratory tract. More details on EAT therapy.
Vagus Nerve Stimulation (VNS): VNS can help regulate the autonomic nervous system and reduce inflammation associated with ME/CFS. Explore VNS options.
Metabolic & Gut-Focused Therapies: Targeted treatment of MCAS/histamine dysfunction and comprehensive gut health restoration.
Important Note: These treatments are individualized. Risks, alternatives, and candidacy are thoroughly reviewed during consultation.
|
Aspect
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ME/CFS
|
Long COVID
|
Fibromyalgia
|
|---|---|---|---|
|
Primary Symptom
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Post-exertional malaise
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Multiple
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Widespread pain
|
|
Trigger
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Ofter Viral infection
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COVID-19 infection
|
Trauma, stress, or unknown
|
|
Fatigue Type
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Severe, unrelieving
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Persistent, variable
|
Related to pain an sleep
|
|
Cognitive Issues
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Persistent Brain fog
|
Difficulty focusing
|
Concentration problems
|
|
Exercise
|
Worsening (PEM)
|
Often worsening
|
Light exercise may help
|
|
Sleep issues
|
Unrefreshing sleep
|
Sleep disturbances
|
Non-restorative sleep
|
Many patients have overlapping conditions, and a large share of people with long COVID meet the diagnostic criteria of ME/CFS, highlighting the importance of comprehensive evaluation.
Dr. Robert Groysman brings unique expertise to ME/CFS treatment as a board-certified interventional pain medicine and anesthesiology specialist.
Dr. Robert Groysman, MD, is a specialist in interventional pain management and anesthesiology who provides exceptional services at Southwest Pain Management (SPM) in Irving, Texas, for patients suffering from long covid, POTS, MCAS, and chronic fatigue syndrome and is a board-certified interventional pain specialist with over a decade of experience in advanced neuromodulation treatments.
Dr. Groysman has been featured in medical podcasts and publications for his pioneering work in treating complex post-viral conditions and brings a compassionate, evidence-based approach to each patient’s journey.
Patient Resources & Next Steps
Getting Started:
Contact Information:
Can chronic fatigue syndrome be cured?
Currently, there is no cure for ME/CFS, but symptoms can be significantly improved with proper management and advanced treatments. Many patients experience meaningful improvement in quality of life with comprehensive care.
Is there a test for ME/CFS?
No single diagnostic test exists for ME/CFS. Diagnosis is made clinically using established criteria, supported by laboratory tests that rule out other conditions causing similar symptoms.
What treatments are available?
Treatment options range from conservative management (pacing, sleep optimization) to advanced interventions like stellate ganglion block, epipharyngeal abrasive therapy, and vagus nerve stimulation. The best approach depends on individual symptoms and medical history.
How is chronic fatigue different from long COVID?
While there’s significant overlap, ME/CFS is defined by specific criteria including post-exertional malaise, while long COVID encompasses a broader range of post-viral symptoms. Many long COVID patients develop ME/CFS, and treatment approaches often overlap.
About the Author: Dr. Robert Groysman, MD, is a board-certified interventional pain medicine and anesthesiology specialist with advanced training in neuromodulation techniques. He specializes in treating complex chronic conditions including ME/CFS, long COVID, and POTS at Covid Institute in Plano, Texas.
Medical Review: This content has been reviewed by the Covid Institute physician team for medical accuracy and current best practices.
References: Centers for Disease Control and Prevention, Institute of Medicine 2015 Criteria, National Institutes of Health, peer-reviewed research on stellate ganglion block and epipharyngeal abrasive therapy for ME/CFS treatment.
Medical Disclaimer
Not all treatments are appropriate for every patient. Risks, alternatives, and off-label uses are reviewed during your consultation before starting care. This information is for educational purposes and should not replace professional medical advice.