Appointment Hotline: (214) 390-7557
Appointment Hotline: (214) 390-7557
Medically reviewed by Dr. Robert Groysman, MD, Diplomate of the American Board of Anesthesiology and the American Board of Pain Medicine | Updated July 2026
Quick answer: Chronic fatigue syndrome, shortened to CFS and also called myalgic encephalomyelitis or ME/CFS, is a real biological illness. It is not deconditioning, and it is not a psychological problem. There is no single lab test for CFS, which is why a standard workup often comes back normal while you stay sick. At Covid Institute in Plano, Dr. Robert Groysman evaluates ME/CFS and post-viral fatigue by identifying which underlying mechanisms are driving your fatigue, then targeting them directly. Patients travel from across Dallas-Fort Worth, including Frisco, McKinney, Allen, Richardson, and Irving, and telemedicine consultations are available for those farther out.
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.
ME/CFS is common and widely underdiagnosed.
In the CDC’s National Health Interview Survey (NCHS Data Brief No. 488, December 2023), 1.3% of U.S. adults reported an ME/CFS diagnosis, with women affected more often than men (1.7% versus 0.9%). Because that estimate counts only people already diagnosed, the true number is likely higher. Many patients develop ME/CFS after a viral infection, including COVID-19 and Epstein-Barr virus.
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 dysautonomia, 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.
For a full picture of how these therapies fit together, see our Long COVID treatment overview, which covers the same mechanism-based approach we use for ME/CFS.
No drug is FDA-approved to treat ME/CFS. Every medication below is prescribed off-label, chosen to target one symptom pattern rather than the illness as a whole, and appropriate only for some patients. What follows is educational context on the options Dr. Groysman may discuss during consultation, not a protocol and not a recommendation for any individual.
Medication Options for Specific Symptoms. Pyridostigmine, approved by the FDA for myasthenia gravis, has the strongest controlled evidence of anything on this list. In a randomized, double-blind, placebo-controlled trial of 45 ME/CFS patients (Systrom and colleagues, Chest, 2022), a single 60 mg dose improved peak oxygen uptake while the placebo group declined, an effect the authors traced to improved cardiac output and venous return. That trial measured one dose in a laboratory, so it does not tell us how patients feel over months. It does something arguably more useful and puts objective physiology behind the crash you experience after exertion.
For cognitive symptoms. Guanfacine, an alpha-2A adrenergic agonist approved for ADHD, has been used off-label for prefrontal problems for years. Yale clinicians combined it with the antioxidant N-acetylcysteine in a small open-label series of 12 patients with post-COVID cognitive deficits (Fesharaki-Zadeh and colleagues, Neuroimmunology Reports, 2023). Eight reported better working memory, concentration, and executive function, several enough to resume normal workloads. Two stopped because of low blood pressure or dizziness. Twelve patients with no control group is preliminary by any standard, and blood pressure needs monitoring.
For pain and immune symptoms. Low-dose naltrexone uses a fraction of the dose approved for opioid dependence, roughly 1 to 4.5 mg, at which it appears to modulate glial activation rather than block opioid receptors. A Finnish retrospective review of 218 ME/CFS patients treated between 2010 and 2014 (Polo, Fatigue: Biomedicine, Health & Behavior, 2019) found 73.9% reported a positive response, most often improved alertness. Insomnia and nausea were common early and settled. Retrospective open-label data cannot separate drug effect from expectation, which is exactly why controlled trials are still needed.
For daytime alertness. Methylphenidate, modafinil, and armodafinil are stimulants and wake-promoting agents approved for ADHD, narcolepsy, obstructive sleep apnea, and shift work disorder. Amantadine, approved for influenza A and Parkinson’s disease, is sometimes used for fatigue in other neurological conditions. Evidence in ME/CFS specifically is thin and mixed. These medications carry a particular risk worth naming: masking fatigue is not the same as restoring energy production, and feeling alert enough to push past your limit is how a crash starts. Any use here belongs alongside pacing, never as a substitute for it.
Which of these makes sense, if any, depends on which mechanisms are driving your symptoms. That is what the diagnostic evaluation is for. Risks, alternatives, interactions, and off-label status are reviewed with you before anything is prescribed.
Dr. Groysman offers innovative interventions targeting the underlying mechanisms of ME/CFS:
Stellate Ganglion Block (SGB): SGB is a precise injection of local anesthetic near a nerve cluster in the neck that helps calm an overactive sympathetic (“fight or flight”) nervous system. Because ME/CFS and Long COVID share autonomic dysfunction, the same approach that helps many Long COVID patients may support recovery here. In a 2023 retrospective cohort (Pearson L, et al., Cureus, 41 patients), most patients reported symptom improvement after SGB; a larger 2025 cohort (Chiang MC, et al., Cureus, 52 patients) found more modest lasting benefit, averaging about three injections. SGB is an off-label use and results vary between patients. Learn more about the stellate ganglion block for Long COVID.
Epipharyngeal Abrasive Therapy (EAT): EAT treats persistent inflammation in the epipharynx, the area behind the nose. In a 2022 study of 58 Long COVID patients (Imai K, et al., Viruses), weekly EAT for one month was associated with reduced epipharyngeal inflammation and improvement in fatigue, headache, and attention, symptoms that overlap with ME/CFS. EAT is an emerging therapy and responses vary between patients. More 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.
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Aspect
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ME/CFS
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Long COVID
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Fibromyalgia
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|---|---|---|---|
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Primary Symptom
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Post-exertional malaise
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Multiple
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Widespread pain
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Trigger
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After Viral infection
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COVID-19 infection
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Trauma, stress, or unknown
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Fatigue Type
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Severe, unrelenting
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Persistent, variable
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Related to pain and sleep
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Cognitive Issues
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Persistent Brain fog
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Difficulty focusing
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Concentration problems
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Exercise
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Worsening (PEM)
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Often worsening
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Light exercise may help
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Sleep issues
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Unrefreshing sleep
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Sleep disturbances
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Non-restorative sleep
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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, MD, is a board-certified interventional pain and anesthesiology specialist with more than a decade of experience in advanced neuromodulation. At Covid Institute in Plano, he treats patients with Long COVID, POTS (postural orthostatic tachycardia syndrome), MCAS (mast cell activation syndrome), and chronic fatigue syndrome (CFS), focusing on the root mechanisms rather than the label.
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 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.
Are there medications for ME/CFS?
No medication is FDA-approved for ME/CFS, but several are used off-label to target specific symptoms. Pyridostigmine has randomized controlled evidence for exercise intolerance, low-dose naltrexone has retrospective evidence for pain and alertness, and guanfacine with N-acetylcysteine has preliminary open-label evidence for cognitive symptoms. Stimulants may improve alertness but do not address the underlying energy failure and can mask the limits that pacing depends on. Which option fits depends on your individual mechanism profile.
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.
References:
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.