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, also called myalgic encephalomyelitis (ME/CFS), is a real biological illness, not deconditioning and not a psychological problem. There is no single lab test for it, 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 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.
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.
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 SGB treatment. 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 details on EAT therapy 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.
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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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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, 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 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.
References:
1. Institute of Medicine (National Academies). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. 2015.
2. Vahratian A, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in Adults: United States, 2021-2022. CDC NCHS Data Brief No. 488, December 2023. PubMed 38085820.
3. Imai K, et al. Epipharyngeal Abrasive Therapy (EAT) Has Potential as a Novel Method for Long COVID Treatment. Viruses. 2022;14(5). PubMed 35632649.
4. Pearson L, et al. Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study. Cureus. 2023. PubMed 37711269.
5. Chiang MC, et al. Stellate ganglion block for the management of Long COVID symptoms: a retrospective cohort study. Cureus. 2025. PubMed 40861640.
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.