US ME/CFS Clinician Coalition Recommendations for ME/CFS Testing and Treatment, April 13, 2021


In its July 2020 handout on ME/CFS diagnosis and treatment, the US ME/CFS Clinician Coalition summarized the alternative diagnoses and comorbidities that need to be evaluated during the differential diagnosis for ME/CFS and also recommended treatment of ME/CFS symptoms and common comorbidities.

The Coalition has now released consensus recommendations for medical providers that include more specifics on the tests and treatments used in caring for people with ME/CFS. The ME/CFS testing recommendations include those tests used to identify alternative diagnoses and comorbidities along with tests to further characterize ME/CFS and to help document disability and guide treatment. These recommendations include a limited set of tests for all patients and additional tests to be ordered based on the patient’s particular presentation. These recommendations are intended as general guidance for a diagnostic process that may extend over several office visits and involve referrals to specialists. The clinician will need to apply their own clinical judgment in deciding which tests to order and whether to refer to a specialist.

The ME/CFS treatment recommendations include pharmacological and non-pharmacological treatments broken down by various aspects of ME/CFS such as orthostatic intolerance, sleep and cognitive impairment, pain, and immune impairment. Comorbidities should be treated using the published standard of care and are not included here. While there is no cure for ME/CFS, treating a patient’s symptoms and comorbidities can help reduce the symptom burden and improve a patient’s quality of life.

These treatment recommendations are intended as general guidance for medical providers and are not a substitute for clinical care by a physician. In deciding on the specific treatment approach, the treating physician should consider the presentation and needs of the individual patient along with up-to-date drug product information for approved uses, dosages, and risks of specific treatments for specific indications. Some people with ME/CFS may have a heightened sensitivity to medications. For these patients, drugs should be started at low doses and increased slowly to avoid triggering drug sensitivities common in ME/CFS.

These recommendations along with additional information on diagnosis and management are available on the US ME/CFS Clinician Coalition website. This Coalition overview is a useful place to start. Medical providers can reach the Coalition at


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