Table 3.

Summary of Literature on Chronic Fatigue Syndrome (CFS) Treatment: Evidence Levels and Treatment Modalities

Study	Evidence pyramid	# of subjects	Type of treatment assessed
Joustra et al.30	Level I	49	Nutritional interventions
Larun et al.28	Level I	1518	Exercise therapy
You et al.31	Level I	1030	Systematic review, Chinese moxibustion
Wang et al.32	Level I	2036	Systematic review, high efficacy/poor quality, more frequent treatments than practiced in USA
Friedberg et al.33	Level II	23	Molecular hydrogen, randomized control
Nilsson et al.34	Level II	62	OSU6162 – a monoaminergic stabilizer – randomized control
Walach et al.35	Level II	409	Distant spiritual healing, randomized control
Crosby et al.36	Level IV	101	Retrospective review of Aripiprazole – off-label use
Fernie et al.37	Level IV	171	Cognitive behavioral therapy (CBT) (116) and graded exercise therapy (GET) (55)
Haghighi et al.38	Level IV	33	OSU6162 – a monoaminergic stabilizer
Kujawski et al.39	Level IV	32/18	Whole body cryotherapy and static stretching – case–control
Nathan and Konynenburg40	Level IV	23	Nutritional supplements – full study no longer available online, unable to evaluate if results were beneficial, no control group
Polo41	Level IV	218	Retrospective review of low-dose naltrexone
Fernandez et al.42	Level V	Review	Found no curative treatment
Bjorklund et al.29	Level V	Review	Nutritional treatment
Brown43	Level V	Review	Current treatments modest benefits, poor prognosis, recommends individualized plan
Mengshoel et al.44	Level V	Review	Review of nonpharmacological therapies
Zhang et al.45	Level V	Review	Reviews Chinese herbs, acupuncture, moxibustion and cupping
Davenport et al.46	Level VI	Case	675 days of IV saline
Royle et al.47	Level VI	Case	Eye movement desensitization and reprocessing
Sharpe et al.48	Level VII	Expert Opinion	Recommend CBT and GET, no known etiology for CFS
Yancey and Thomas49	Level VII	Expert Opinion	Only efficacious treatment CBT and GET