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History of myalgic encephalomyelitis and chronic fatigue syndrome
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==Post-exertional malaise as the hallmark symptom and treatments withdrawn== A shift in diagnostic criteria and symptom focus began around 2015-2016, with greatly reduced emphasis on [[fatigue]] and with [[post-exertional malaise]] (PEM) required as a compulsory symptom and frequently referred to as the "hallmark symptom" of ME/CFS. The disease is increasingly referred to as ME/CFS or Myalgic Encephalomyelitis/Chronic Fatigue Syndrome rather than [[Chronic fatigue syndrome]], including by the CDC from 2017.<ref name="CDC-symptoms" /> This change in emphasis has largely resulted from the release of the full [[PACE trial]] outcome data in 2016, and the subsequent re-analysis of the [[Cochrane]] review of [[graded exercise therapy|exercise therapy]] for ME/CFS, which showed that treatment outcome results and impairment differed when post-exertional malaise was a required symptom.<ref name="PTP2015">Green CR, Cowan P, Elk R, OβNeil KM, Rasmussen AL (2015). National institutes of health pathways to prevention workshop:advancing the research on myalgic encephalomyelitis/chronicfatigue syndrome. Ann Intern Med 162: 860β865.</ref><ref name="Wilshire2017">{{Cite journal | last = Wilshire | first = Carolyn | last2 = Kindlon | first2 = Tom | last3 = McGrath | first3 = Simon | date = 2017-01-02 | title = PACE trial claims of recovery are not justified by the data: A Rejoinder to Sharpe, Chalder, Johnson, Goldsmith and White (2017) | url = https://www.researchgate.net/publication/315482747_PACE_trial_claims_of_recovery_are_not_justified_by_the_data_A_Rejoinder_to_Sharpe_Chalder_Johnson_Goldsmith_and_White_2017|journal=Fatigue: Biomedicine, Health and Behavior|volume=5|issue=1|pages =62-67|doi=10.1080/21641846.2017.1299358}}</ref><ref name="Smith2016">{{cite journal | vauthors = Smith ME, Nelson HD, Haney E, Pappas M, Daeges M, Wasson N, McDonagh M | title = Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome No. 219| journal = Evidence Report/Technology Assessment | pages = 1β433 | date = December 2014 | pmid = 30313001 | doi = 10.23970/AHRQEPCERTA219 | url = https://www.ncbi.nlm.nih.gov/books/NBK379582/ | publisher = Agency for Healthcare Research and Quality (US) | quote = The results are consistent across trials with improvement in function, fatigue, and global improvement and provided moderate strength of evidence for improved function (4 trials, n=607) and global improvement (3 trials, n=539), low strength of evidence for reduced fatigue (4 trials, n=607) and decreased work impairment (1 trial, n=480), and insufficient evidence for improved quality of life (no trials) | doi-access = free }}</ref> [[Graded exercise therapy]] and [[cognitive behavioral therapy]] were found to be either harmful or ineffective for the vast majority of patients with post-exertional malaise, and the recommendations for the and withdrawn by the CDC in 2017, and mostly abandoned by the UK's [[National Health Service]] from late 2021.<ref name="Wilshire2017" /><ref name="niceng206">{{Cite web | url=https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group | first = | authorlink = | publisher = [[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref> The [[biopsychosocial model]] was largely abandoned, with ME/CFS regarded as a serious physical disease, and a greater focus on the biomedical model for diagnosis and treatment, and future research.<ref name="Dutch2018" /><ref name="IOM2015" />
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