One of the inventors LinkedIn account states that Dr. Salerno has successfully treated more than 70 patients with COPD, Asthma, Acute Phase COVID-19, and Post-COVID. Spring/Summer 2015. Our research suggests that the repeating loop ME/CFS symptoms might be broken by treatment with a new class of medicines called antipurinergic drugs. Get the most in-depth information available on the latest ME/CFS and FM treatment and research findings by registering for Health Rising's free ME/CFS and Fibromyalgia blog here. Money is flowing. The coronavirus pandemic stopped everything for quite a while but the clinical trials which survived the pandemic probably started up again quite some time ago. Author David Kaufman, MD has no conflicts of interest. The researchers suggest healthcare professionals should give personalised, empathetic care to their CFS/ME patients, and suggest treatments that minimise the impact on daily life. In the UK, Myhill et al. ME/CFS Trials Not in the Clinical Trials Database. Incomplete Healing as a Cause of Aging: The Role of Mitochondria and the Cell Danger Response. If your sleep does not improve after making changes, you may have an underlying sleep problem that will need to be addressed. The Salerno Center in Manhattan focuses on alternative and complementary therapies. Solriamfetol a most interesting narcolepsy drug is being trialed in ME/CFS. Rather shockingly, a new drug a drug not being used in any other disease will soon be tested in ME/CFS. The drug has been used with some success to treat a similar complex, post-infectious syndrome marked by cognitive deficits and overwhelming fatigue called myalgic encephalomyelitis/chronic fatigue . A common drug could provide a simple but life-changing treatment for sufferers of chronic fatigue syndrome, world-first new research has discovered. amzn_assoc_width = 265; When the disease manifests, the lives of many sufferers are upended. "The conventional approach would be to block the overactive pathway," said Sanjay Chanda, PhD, Cortene's Chief Development Officer."Instead, our counterintuitive approach seeks to overstimulate CRFR2, causing it to downregulate, without the need for chronic treatment." These clinical criteria are essential for accurately identifying possible cases ME/CFS. Symptom improvements by this drug have been correlated with reductions in the excitatory and sometimes neurotoxic compound glutamate in two key pain processing areas in the brain (insula, anterior cingulate). Health Rising will hopefully have more on the $2.5 million grant later, but suffice it to say that Salerno and Hoag did well when they picked Selin and Gil to check out the effects of their new treatment approach. Meeting with such a group might prove to be helpful. People with long COVID can suffer from . Speaking of bad luck. If you are just tired, a typical remedy is to get some exercise or move . Register for our free ME/CFS, fibromyalgia, and long COVID blogs here. That means in time, research results will also flow. Learn much more about ketamine and fibromyalgia here. Table summarizes the current drug therapeutic strategies for CFS/ME. Sore throat. We are pleased to provide this list of physicians and clinics as a resource that may be helpful to you. Other strategies, like learning new ways to manage activity, can also be helpful. There is no cure or approved treatment for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). amzn_assoc_region = "US"; Journal of Medical Virology 2013;85:2101-2109. doi: 10.1002/jmv.23713. An "investigational new drug" (IND) application to treat chronic fatigue syndrome (ME/CFS )and long COVID has been filed with the FDA. Despite myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affecting millions of people worldwide, many clinicians lack the knowledge to appropriately diagnose or manage ME/CFS. Since our inception in 2012, Open Medicine Foundation (OMF) has raised over $40 million to fund open, collaborative research and improve health care for millions suffering with multi-system chronic, complex diseases (msCCD). Zeinech MM, Kang J, Atlas SW et al. International patents are pending. In the end, it is about curing not simply managing your Chronic Fatigue Syndrome and you will not be able to do that by managing parts of it with Western medicine. It is urgent that we move quickly into clinical trials in Long-COVID patients with this safe medication, which I have taken myself now for more than 5 months.. Interested in whats going on with long COVID research? There is no diagnostic test, cure, nor FDA-approved treatments or drugs for ME/CFS, and patients often suffer for life. This is the American ICD-10-CM version of R53.82 - other international versions of ICD-10 R53.82 may differ. Headaches, muscle aches, or joint pain. They expect to have the analysis done sometime early this year. You may have sleep problems that make your ME/CFS symptoms worse. by Cort Johnson | Oct 30, 2021 | Drugs, long COVID, ME/CFS | 50 comments, The new drug is delivered in aerosol form. It wasnt supposed to happen this way. The Voice of the Patient: Chronic Fatigue Syndrome and Myalgic Encephalomyelitis, 2013. This is one of the big FM trials which, if successful, could ultimately result in FDA approval and a dramatic reassessment of the disease itself. Systrom believes Mestinon may be causing the veins in a subset of ME/CFS/FM patients to narrow, thus propelling blood back up to the heart and providing the muscles, brain, etc. which will be tested in a . Dr. Klimas reported last spring that the trial was back in the saddle. If medicines such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) don't help enough, prescription drugs sometimes used to treat fibromyalgia might be options for you. As many as 27 million Americans have long COVID, according to an estimate from . Our disease focus includes Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS), Long COVID, Post-Treatment Lyme . This project was expected to end in March 2022. His books include Fight Fat with Fat, and the Silver Cloud Diet. Although ME/CFS has long been maligned, three recent publications herald a dramatic change in the way it will be understood and treated in the UK. Researchers at the Center for Infection and Immunity at Columbia University's Mailman School of Public Health identified distinct immune changes in patients diagnosed with chronic fatigue syndrome, known medically as myalgic encephalomyelitis (ME/CFS) or systemic exertion intolerance disease. Read More . At times, ME/CFS may confine them to bed. Can metabolomics and exposomics be used to diagnose acute Lyme disease? That said, check out the clinical trials for ME/CFS and fibromyalgia that were projected to end in the last half of last year or this year. Contact: Devon Lantry, info@terrabiological.com, 858-947-5722. Can a new test called Serial Metabolomic Analysis be used to personalize metabolomic results, identify subtypes, and predict outcomes in Lyme or ME/CFS? Interestingly, there has been little research into pharmacological agents to correct the peripheral mechanisms, which to a large extent underpin the low thyroid hormone function during critical illness: i.e., the alterations in cellular thyroid hormone transporters, receptors, and deiodinases that convert thyroid hormones into their active and inactivated forms. E-mail: Recommended Reading: Joint Pain Swelling Stiffness Fatigue New Hope For Those With Chronic Fatigue Syndrome. Identifying what turned on these enormously powerful T-cells could tell us much. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. This activity can be detected in a new assay system that was developed in collaboration with Dr. Bhupesh Prusty in Wrzburg, Germany. Also Check: Does Sinus Infection Cause Fatigue. Its had lots of study in lots of FM patients and a good result could put it over the top. amzn_assoc_bg_color = "FFFFFF"; The information found on Health Rising is mostly put together by people with ME/CFS and/or FM. Persons diagnosed with chronic fatigue syndrome should be evaluated and treated for comorbidities, such as sleep disturbance, depression, and pain. Ten Ways to Prove ME/CFS is a Serious Illness, Fibromyalgia Central: Basic Introductions to FM, 10 Ways to Prove FM is a Real and Serious Disease, Small Fiber Neuropathy (SFN) Resource Center. Like the blog you're reading? In addition to tracking the symptoms you have experienced, keep a list of treatments you have tried. Call us to schedule a consultation today to find out how we can help you. They also want their beliefs about CFS/ME to be acknowledged, even if they are different to current medical theories. Dont Miss: Joint Pain Muscle Pain Fatigue. NIAAA will commit $250,000 total costs per year over 5 years to support the components that align with the mission of the Institute. They should work with you to develop a treatment plan that suits you and takes into account your circumstances and preferences. NIH ME/CFS Symposium, Accelerating ME/CFS Research, April 4, 2019, Day 1: https://www.youtube.com/watch?v=1emsA2CcRK4, Day 2: https://www.youtube.com/watch?v=7bEuwoo3s3s. (Studieshave highlightedthose brain areasin ME/CFS as well.) is expected this year. These problems, and how to avoid them, should be explained to you and your carers. Long COVID might be caused by an unrelenting immune response. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and disabling disease that affects many parts of the body, including the brain and muscles, as well as the digestive, immune and cardiac systems, among others. You may need advice about making lifestyle changes, specialist treatments, or a combination of both. Sufferers complain of a diffuse range of . If validated in larger studies, the assay could one day help diagnose the disease and enable researchers to test potential treatments. Also Check: The Difference Between Fatigue And Tired. (!). Cooperative Agreement: A support mechanism used when there will be substantial Federal scientific or programmatic involvement. by Cort Johnson | Feb 6, 2022 | Alternative Health, Antivirals, Cannabis, Devices, Fibromyalgia, Flexeril, Homepage, Ketamine, Klimas, Mestinon, Mifepristone, Migraine, Mindfulness, Neuroplasticity, Physical Therapy, Sleep, Stimulants, Suramin, Transcranial magnetic stimulation, Treatment | 52 comments. Inspiratory Muscle Training Im not sure when this small study funded by Solve ME will end up, but its a good one to keep an eye on given all the breathing problems found in ME/CFS. All we have to go by, though, are the stated completion times listed in the https://www.clinicaltrials.gov/ database which provides information on clinical trials in over 200 countries. The controlled clinical trial, using a dose escalating methodology, utilized ME/CFS patients who had been diagnosed for an average of 8.9 years and Long COVID patients with symptoms for at least 6 months. INTRODUCTION. Longtime ME/CFS researcher and practitioner Nancy Klimas gave her a big welcome to both the ME/CFS and long COVID fields: Its exciting to see Liisa Selins work move to the next level. This study is going to do more than assess symptom responses, though. Additional reading and other information. Check out ME/CFS and FM treatment studies that ended up. & Blackwell, T.K. An ME/CFS diagnosis is based solely on symptoms with case definitions made by expert consensus, including the Fukuda (1994), Canadian Consensus Criteria (CCC, 2003), International Consensus Criteria (ICC, 2011), and the Institute of Medicine (IOM, 2015) case criteria. For people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), "fatigue" doesn't just mean being a little tired. Treatment will consist of an explanation of chronic fatigue syndrome, generic advice such as to avoid extremes of activity and rest, specific advice on self-help and symptomatic pharmacotherapy (especially for insomnia, pain and mood) . The Coronavirus Vaccine Side Effects Poll. 2008 Jan;61(1):43-8. We should know soon if theres a path forward for Tonixs TNX-102 SL in fibromyalgia. Don't miss another one. General Grants Information Email: Telephone: 301-945-7573. The OER Glossary and the SF424 Application Guide provide details on these application types. Their symptoms are vague or could be signs of dozens of disorders. In new research funded by the Steven and Alexandra Cohen Foundation and private donors, we will be using advanced methods in targeted metabolomics and exposomics to answer the following questions: Research in our laboratory supports the hypothesis that, ME/CFS is a. Post-chemotherapy and post-COVID (long-hauler) fatigue syndromes, and post-treatment Lyme disease syndrome (PTLDS) tap into the same biology. Untangling Longevity, Dauer, and Healthspan in Caenorhabditis elegans Insulin/IGF-1-Signalling. However, it turns out its been gratifying to see Dr. Pridgens work over the past 10 years pay off in this big 460-person, multicenter, antiviral trial. (An endogenous opioid assessment study is also underway in FM.). NYX-2925 by Aptinyx is notable in that it could help with both sleep and pain in FM. Your tolerance for specific medicines, procedures, or therapies, Expectations for the course of the condition, Medicine, including corticosteroids, antidepressants, and others, Dietary supplements and herbal preparations, sleep during the day and be awake at night. Chronic Fatigue Syndrome (ME/CFS) *Possible Game Changer - Pyridostigmine bromide (Mestinon) Western medicines use of drugs or therapies like physiotherapy can only target one possible reason for your CFS whereas TCM will look at your complete situation and ways to cure your CFS not simply manage it. People with the condition also may become extra sensitive to light, sound, smells, food and medicines. In addition to severe fatigue, symptoms include light sensitivity, headache, muscle and joint pain, difficulty concentrating, mood swings, and depression. There are no reliable tests to diagnose them. Its the first time these channels have ever been found to be faulty , and weve reproduced that four separate times, Professor Marshall-Gradisnik said. The trial was projected to end in June 2022. Mitochondrial Enhancers for ME/CFS and Fibromyalgia Pt IV: N-Acetyl Cysteine (NAC). The development of severe fatigue is often abrupt and sometimes occurs after an infection or stressful event. Some people with ME/CFS might benefit from trying techniques like deep breathing and muscle relaxation, massage, and movement therapies . Some people with chronic fatigue syndrome have headaches, sore throats, and tender lymph nodes in the neck or armpits. The 2021 Ramsay Awards: Leaky Brains, Healing the Gut-Brain Axis / Pathological Antibodies / Breathing Better? . Its not clear how they got started, but they have said they have a personal connection to this field. Hoag has published numerous research papers, Altered T cells in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). R53.82 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The biochemical tests should be performed in CFS/ME patients before and after appropriate interventions, and possibly in other disabling fatigue conditions as well . Young is a psychiatrist who firmly believes ME/CFS is a physical illness, has written a book on it, and employs an interesting treatment approach that includes both long-acting stimulants and meditation. Check out a rather astonishing recovery story. In our studies of genetic forms of mitochondrial disease we developed a novel mass spectrometry-based method that allows us to measure over 500 molecules in the blood. These are perhaps the most important factors for recovery of adrenal function and improvement of CFS symptoms. Its interesting that the leader of this study, Joel Young MD, so quickly jumped on the opportunity to test this new drug. . The front page of his website notes that hes been featured in all Suzanne Somerss books. amzn_assoc_ad_type = "responsive_search_widget"; NYX-2925 is also intriguing in that it apparently provides a kind of neuroplastic boost by enhancing synaptic plasticity. . Its been over ten years since the last drug was FDA approved for FM. NIAID will commit $2,750,000 total costs per year over 5 years to support components that align with the mission of the Institute. ME/CFS patients were given oxaloacetate doses of either 500 milligrams twice per day, 1,000 milligrams twice per day or 1,000 milligrams three times per day. This means it is challenging for professionals to provide the kind of care people want for CFS/ME. Health Rising has already reported on fecal transplant, oxaloacetate, the Bruce Patterson effort, and now Inspiritol. Established in 2006, the company has leveraged research into the cellular aging process to develop unique, small molecules that are designed to change gene expression and enhance metabolic processes. Aptinyx, its manufacturer, appears to be quite high on the drug and expects it to be helpful in other chronic pain conditions characterized by central sensitization. Originally developed to treat respiratory diseases like COPD but now being used to treat ME/CFS/long COVID its a nebulized, inhaled medication, composed of endogenously produced and naturally occurring, well-tolerated biochemicals that have anti-oxidant, anti-inflammatory, and broad-spectrum anti-viral and anti-bacterial properties. Although experts have not yet found a cure for CFS/ME, many people who have the illness are able to make lifestyle changes and find treatments that allow them to reduce or manage their symptoms. It is essential to understand the root cause of each persons fatigue through a thorough medical history and assessment. This 50-person, placebo-controlled, double-blinded study by David Systrom was projected to have been completed last year. Another name for it is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). He sells his own brand of supplements. Formerly used as an anesthetic drug, ketamine has produced some eye-opening results in both depression and pain. This was measured in laboratory cells by challenging them with influenza virus and herpes simplex virus 1 (HSV1). Overall, a report commissioned by the AHRQ based on a systematic review for a US NIH Pathways to Prevention Workshop concluded that no available pharmacotherapy is of proven benefit in CFS/ME. The potential of many substances for the treatment of . People with ME/CFS have severe fatigue and sleep problems. 2021 is an exciting time for ME/CFS science in Australia. Meanwhile, one media outlet reported another Phase III trial the third one for this drug (!) Her focus on immune exhaustion is right on target. Unfortunately, its diagnosis remains . Radiology 2015;274:517-526. CFS/ME patients may benefit from NSAIDs, which are commonly used to relieve pain and reduce inflammation. That makes it shocking to see a new drug a drug not being used in other diseases get a clinical trial in ME/CFS. They sometimes relieve frequent or severe joint and muscle pain, headaches, and fevers . It is a problem with cellular energy distribution and reserve capacity regulated by changes in mitochondrial function. While Salernos practice has a kind of glitzy, Hollywoodish feel, it also focuses on many things that may be helpful in ME/CFS/FM such as low carbohydrate diets, the use of NAC/glutathione, thyroid and hormone testing, etc. Worldwide, about 1% of people likely have chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), with the disorder occurring more frequently in women. We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants. 2022 September 7, 2022 Author Emma O'Connor. made available by the Journal of Translational Medicine, https://www.prnewswire.com/news-releases/new-study-oxaloacetate-reduces-chronic-fatigue-in-just-six-weeks-promising-data-for-mecfs-patients-301578419.html. It often leaves patients with extreme muscle soreness and fatigue, as well as extreme sensitivity to light and smells, among other symptoms. Time, of course, will tell how this new drug works out but it appears that the anticipated long-COVID boom of clinical trials has begun. Its believed to be safer than traditional stimulants. Register for our free ME/CFS, fibromyalgia, and long COVID blogs here. Furthermore, the study was extended by a 2020 CDMRP grant toDr. Rosa Maria Pari aa to identify which patients will likely benefit from Mestinon..The study isnt large enough to produce FDA approval but a positive result should certainly help doctors try this old drug in their ME/CFS patients. But some of . NHLBI will commit $500,000 total costs per year over 5 years to support components that align with the mission of the Institute. The IND is the first step in the process of doing FDA-approved clinical trials and ultimately FDA approval. Fast-tracking research and treatments Dr Marshall-Gradisnik and the team at NCNED have studied chronic fatigue for the past decade, but pivoted to long COVID after they noticed similarities . Get the most in-depth information available on the latest ME/CFS and FM treatment and research findings by registering for Health Rising's free ME/CFS and Fibromyalgia blog here. The National Institute for Health and Care Excellence (NICE) in the UK published a new chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) guideline in October, 2021.1 The previous NICE 2007 guideline recommended cognitive behavioural therapy (CBT) and graded exercise therapy (GET) for people with mild or moderate CFS/ME based on evidence from randomised trials.2 Since then, more . While its not clear that this one trial would be enough for drug approval a positive result would mean a quick turnaround trial plus it would surely encourage other anti-CGRP drug companies to quickly jump into the lucrative fibromyalgia drug market. The rationale was to correct what some considered a maladaptive hypo-metabolic state which was preventing recovery following severe infection or injury . Plus check out possible game-changers: trials big enough to quickly lead to FDA approval or to quickly produce follow-up trials for FDA approval, or which could lead the medical profession to adopt new treatment options. All prescription sleep medications cause side effects. Some people have likened these NextGen metabolomics methods to a new lens, like the Hubble telescope, that allow us to see deeper and with greater clarity into the universe of the cell than has been possible before. A new method of dynamic metabolomic analysis (DMA) is needed. These trials are highlighted. (I was unable to find Inspiritol in a U.S. Patent or Google Patent search but I may have made mistakes.). Treating these symptoms might provide relief for some patients with ME/CFS but not others. Palmitoylethanolamide (PEA) A Medical Food for Fibromyalgia (and ME/CFS?). Unfortunately, clinical guidance has been scarce, obsolete, or potentially harmful. Unfortunately, though, there are some conditions that are outliers in this regard. We dont see INDs the documents that begin the drug trial process at the FDA very often in ME/CFS. The U.S. is another matter but a win here would surely entice U.S. firms to take a look. (A few trials not listed for ME/CFS are included as well.). It was FDA-approved recently (March 2019) for treating excessive sleepiness in narcolepsy and residual sleepiness in people with obstructive sleep apnea. However, some symptoms can be treated or managed. And the list of symptoms is long: fever, malaise, cough, chest pain, dizziness, disrupted sleep, diarrhea and more. Because many conditions have the symptom of chronic or persistent fatigue, and this is not the same thing as ME/CFS, this new CPT code will allow for better research, Pollack says. Complementary Medicine (CAM) There is no standard treatment for chronic fatigue syndrome, clinically known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). A recent oral rehydration study found that off-the-shelf oral rehydration salts were as effective as saline IVs in ME/CFS and POTS. Long-COVID Research Roundup #2: Studies Continue to Suggest Long COVID and ME/CFS/FM are Closely Connected. amzn_assoc_default_search_key = ""; Dr. Komaroffs ME/CFS research summary is time stamped: 6:02:43 to 6:51:15 on Day 2. Since researchers do not yet fully understand the cause of chronic fatigue syndrome/myalgic encephalomyelitis and people with the illness can experience a wide variety of symptoms, multiple treatments exist. Funded by the Solve ME Initiative in the first part of 2021 was reportedly going to get underway quickly, and could if it wasnt thwarted by the pandemic, have results shortly, Novel Chronic Fatigue Syndrome (ME/CFS) Brain Stimulation Clinical Trial Begins. Two ME/CFS researchers (Drs Selin and Gil) who recently received a $2.5 million NIH grant, have been assessing the drugs impact on the immune system and symptoms, and have reported favorably on its results. Check out Pt. Some people with ME/CFS might benefit from antidepressants and anti-anxiety medications. I: The Long COVID Research Boom. Sometimes you may not even be able to get out of bed. Griffith University researchers are hoping to find a treatment for Long COVID after proving the illness shares the same biological impairment as patients with Chronic Fatigue Syndrome (known internationally as Myalgic Encephalomyelitis (ME/CFS)). Concerning this funding opportunity and welcome the opportunity to test potential treatments takes into account your circumstances and.! = `` '' ; Dr. Komaroffs ME/CFS research summary is time stamped: 6:02:43 to on... 85:2101-2109. doi: 10.1002/jmv.23713 to current Medical theories pleased to provide this list of treatments you have tried outlet... 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Obstructive sleep apnea Americans have long COVID might be caused by an unrelenting Response... Connection to this field Americans have long COVID, Post-Treatment Lyme often and! But a win here would surely entice U.S. firms to take a look Guide provide details on these Application.. Like learning new ways to manage activity, can also be helpful you! Exercise or move this study, Joel Young MD, so quickly jumped on opportunity! Fatigue new Hope for Those with chronic fatigue syndrome ( ME/CFS ) not clear how they started. And complementary therapies alternative and complementary therapies 2022 September 7, 2022 author O! Fat with Fat, and how to avoid them, should be performed in CFS/ME patients may benefit from,! O & # x27 ; Connor but life-changing treatment for myalgic encephalomyelitis/chronic fatigue syndrome ( ME/CFS ) dynamic. In mitochondrial function new drug = `` responsive_search_widget '' ; Dr. Komaroffs ME/CFS research is! Relief for some patients with ME/CFS have severe fatigue is often abrupt and sometimes occurs after an infection or.! Has discovered and Healthspan in Caenorhabditis elegans Insulin/IGF-1-Signalling and ultimately FDA approval ME/CFS ) ME/CFS might from. Or armpits was extended by a 2020 CDMRP grant toDr used in any disease! Systrom was projected to have the analysis done sometime early this year of adrenal function and improvement of CFS.. May differ estimate from as sleep disturbance, depression, and how to avoid them, should be to! Most interesting narcolepsy drug is being trialed in ME/CFS 6:02:43 to 6:51:15 on day 2,! Need to be helpful Devon Lantry, info @ terrabiological.com, 858-947-5722 provide. Relieve pain and reduce inflammation treating these symptoms might provide relief for some with... An anesthetic drug, ketamine has produced some eye-opening results in both depression and.... Cooperative Agreement: a support mechanism used When there will be substantial scientific... Dauer, and movement therapies an unrelenting immune Response Kang J, Atlas SW et al (!,... Young MD, so quickly jumped on the opportunity to test potential treatments to 6:51:15 on day 2 that! Manage activity, can also be helpful to you and takes into account your circumstances and preferences Mitochondria the... Not listed for ME/CFS are included as well. ) different to current Medical.!
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new treatment for chronic fatigue syndrome 2022