Condition

Chronic Fatigue Syndrome

ME/CFS - Extreme fatigue not improved by rest

71M
People Affected
40
Active Trials
1.4M
New Cases/Year
500
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Activity Pacing / Energy Management
65% Effectiveness• 80% Confidence• 95% Safety• 30 trials• 3K participants
MODERATE EvidenceExcellent ValueDose: Individualized, e.g., managing activity within individual energy envelope, taking regular rest breaks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

1-3 months

Duration

Lifetime

Response Rate

65%

Remission Rate

3%

Common Side Effects:

Frustration: 5%
Social isolation: 3%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,000

Side Effects

$0

Total Annual

$1,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

Cost per Remission

$3,333

Cost per Responder

$154

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+65%
Response Rate
+65%
Remission Rate
+3%
Common Side Effects
Frustration
+5%
Social isolation
+3%
2
Cognitive Behavioral Therapy (CBT) adapted for ME/CFS
60% Effectiveness• 70% Confidence• 90% Safety• 2 trials• 7.5K participants
MODERATE EvidenceGood ValueDose: 12-18 sessions over 3-6 months, typically 1 hour/session
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
DangerousModerateSafe

Time to Effect

3-6 months

Duration

12-24 weeks

Response Rate

50%

Remission Rate

8%

Number Needed to Treat (NNT)

7

Common Side Effects:

Increased anxiety: 5%
Frustration: 5%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,000

Side Effects

$0

Total Annual

$1,000

Cost-Effectiveness

GOOD

QALYs Gained

0.2

Cost per Remission

$31,250

Cost per Responder

$5,000

Treatment Outcomes
Primary Outcomes
Fatigue Severity (Chalder Fatigue Scale)22/33 points
-25% (-5.5 points)
Physical Functioning (SF-36 subscale)35/100 points
+20% (+7 points)
Sleep Quality (Pittsburgh Sleep Quality Index)14/21 points
-15% (-2.1 points)
Pain Severity (NRS 0-10)6.5/10 points
-15% (-1.0 points)
Secondary Benefits
Anxiety Symptoms (HADS-Anxiety)13/21 points
-20% (-2.6 points)
Depressive Symptoms (HADS-Depression)11/21 points
-20% (-2.2 points)
Social Functioning (SF-36 subscale)45/100 points
+15% (+6.8 points)
Common Side Effects
Increased anxiety
+5%
Frustration
+5%
3
Naltrexone (low-dose)
55% Effectiveness• 60% Confidence• 80% Safety• 3 trials• 750 participants
LOW EvidenceExcellent ValueDose: 1.5mg to 4.5mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
80
DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

Long-term

Response Rate

40%

Remission Rate

2%

Common Side Effects:

Nausea: 12%
Insomnia/Vivid dreams: 15%
Headache: 7%

Annual Cost of Care

Drug Cost

$500

Monitoring

$200

Side Effects

$50

Total Annual

$750

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

Cost per Remission

$37,500

Cost per Responder

$1,875

Treatment Outcomes
Primary Outcomes
Fatigue Severity5.8/7 on Fatigue Severity Scale (FSS)
-20.7% (-1.2 points)
Pain Intensity6.2/10 on Numeric Rating Scale for pain
-21% (-1.3 points)
Physical Functioning32/100 on SF-36 Physical Functioning subscale
+34.4% (+11 points)
Cognitive Symptoms (Brain Fog)7.0/10 on Cognitive Symptoms Scale
-21.4% (-1.5 points)
Secondary Benefits
Overall Quality of Life30/100 on SF-36 Vitality subscale
+30% (+9 points)
Sleep Quality13/21 on Pittsburgh Sleep Quality Index (PSQI)
-19.2% (-2.5 points)
Social Functioning40/100 on SF-36 Social Functioning subscale
+25% (+10 points)
Common Side Effects
Nausea
+12%
Insomnia/Vivid dreams
+15%
Headache
+7%

Clinical Trial Phases:

Phase 2Phase 3
4
Amitriptyline
45% Effectiveness• 70% Confidence• 60% Safety• 12 trials• 750 participants
MODERATE EvidenceExcellent ValueDose: 10-50mg at bedtime
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term

Response Rate

30%

Remission Rate

2%

Common Side Effects:

Dry mouth: 35%
Drowsiness/Sedation: 25%
Constipation: 20%
Weight gain: 15%
Dizziness: 12%

Annual Cost of Care

Drug Cost

$100

Monitoring

$200

Side Effects

$75

Total Annual

$375

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

ICER

$25,000/QALY

Cost per Remission

$18,750

Cost per Responder

$1,250

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+45%
Response Rate
+30%
Remission Rate
+2%
Common Side Effects
Dry mouth
+35%
Drowsiness/Sedation
+25%
Constipation
+20%

Clinical Trial Phases:

Phase 4
5
Sertraline
40% Effectiveness• 80% Confidence• 60% Safety• 15 trials• 1.5K participants
MODERATE EvidenceExcellent ValueDose: 50-200mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

4-6 weeks

Duration

6-12 months

Response Rate

30%

Remission Rate

3%

Common Side Effects:

Nausea: 25%
Insomnia/Somnolence: 20%
Diarrhea: 15%
Sexual dysfunction: 25%

Annual Cost of Care

Drug Cost

$180

Monitoring

$400

Side Effects

$100

Total Annual

$680

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

ICER

$30,000/QALY

Cost per Remission

$22,667

Cost per Responder

$2,267

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+40%
Response Rate
+30%
Remission Rate
+3%
Common Side Effects
Nausea
+25%
Insomnia/Somnolence
+20%
Diarrhea
+15%

Clinical Trial Phases:

Phase 4
6
Magnesium supplements
30% Effectiveness• 40% Confidence• 85% Safety• 7 trials• 350 participants
VERY-LOW EvidencePoor ValueDose: 200-400mg elemental magnesium daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
85
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Ongoing

Response Rate

15%

Remission Rate

0.5%

Common Side Effects:

Diarrhea: 15%
Nausea: 5%

Annual Cost of Care

Drug Cost

$240

Monitoring

$1,000

Side Effects

$10

Total Annual

$1,250

Cost-Effectiveness

POOR

QALYs Gained

0.01

Cost per Remission

$50,000

Cost per Responder

$1,667

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+30%
Response Rate
+15%
Remission Rate
+0.5%
Common Side Effects
Diarrhea
+15%
Nausea
+5%