SEMG helps physicians understand the differential diagnosis of myalgic encephalomyelitis, the reality of patients’ experiences, and the importance of humanizing their care

• The virtual workshop addressed the key clinical indicators for recognizing this disease, identifying post-exertional neuroimmune exhaustion, and avoiding recommendations that could worsen symptoms.

• It was organized in collaboration with the Association of People with Myalgic Encephalomyelitis (PEM), whose representatives gave voice to the daily difficulties and invisibility faced by many people affected by the condition.

October 27, 2026 – The Spanish Society of General Practitioners and Family Physicians (SEMG) and the Association of People with Myalgic Encephalomyelitis (PEM) held a virtual conference yesterday afternoon, Monday, October 26, Beyond Fatigue: Differential Diagnosis of Myalgic Encephalomyelitis (ME/CFS), aimed at medical professionals in primary care and the hospital setting.

SEMG President Dr. Pilar Rodríguez Ledo welcomed the attendees and highlighted the need to distinguish myalgic encephalomyelitis from ordinary fatigue, as well as the profound impact of the disease on the independence and daily lives of those who suffer from it.

Rodríguez Ledo warned that standard recommendations for physical activity could be counterproductive if the characteristics of the disease and individual tolerance for exertion were not taken into account. “Sometimes, with the best of intentions, we recommend gradually increasing physical activity, and this can be counterproductive if we do not take into account the specific characteristics of the disease and individual tolerance for exertion,” he explained.

For this reason, he advocated for the need to improve the training of healthcare professionals so they can recognize the specific characteristics of this disease and provide care tailored to each patient. He also emphasized the role of family physicians in the clinical assessment, follow-up, and support of those affected.

Distinguishing Types of Fatigue to Guide Diagnosis

Dr. Eva Martín, a specialist in Family and Community Medicine at the Manises Hospital (Valencia), a member of the European Group of Medical Experts on Myalgic Encephalomyelitis (EMECC) and a collaborator with Dr. Elisa Oltra’s research team at the Catholic University of Valencia, discussed the key clinical indicators for recognizing the disease.

The specialist explained the importance of distinguishing between physiological tiredness—which usually improves with rest—and fatigue secondary to other illnesses, as well as pathological fatigue, which can be persistent, disproportionate to the effort expended, and limiting to daily activities.

To guide the evaluation, he recommended assessing whether the patient had reduced their usual activities, presented other associated symptoms, or experienced a worsening of symptoms when attempting to maintain their activity level despite fatigue. These signs could indicate the need for a more specific evaluation and the application of the diagnostic criteria for myalgic encephalomyelitis.

Martín also reviewed other associated symptoms, such as brain fog, sleep disorders, pain, and autonomic nervous system disorders. Among the latter, he highlighted orthostatic intolerance, which can cause dizziness, weakness, and palpitations when standing.

Exercise-induced neuroimmune exhaustion: a key indicator

One of the main themes of the conference was post-exertional neuroimmune exhaustion (PNIE), characterized by a worsening of symptoms after physical, cognitive, or emotional activities, even when the exertion appears minimal.

Dr. Martín emphasized that recognizing this phenomenon was essential for guiding the diagnosis and tailoring recommendations to each person’s capabilities. In the most severe cases, the worsening of symptoms could be prolonged and prevent the person from performing daily tasks or returning to their previous state of health.

The patient experience: key to improving care

The event was moderated by María Asunción Gracia Aznar, third vice president of SEMG, and also featured the participation of Mari Carmen Motos, president of PEM, and Marian Lozano, secretary of the association, both of whom are patients with myalgic encephalomyelitis.

PEM representatives presented the association’s work and highlighted the role of the expert patient, whose knowledge of the disease based on direct experience can help healthcare professionals better understand the needs of those affected.

They also highlighted the difficulties patients face in their daily lives. In the most severe cases, seemingly simple actions can require extraordinary effort, while others face a lack of understanding stemming from a condition whose limitations are not always visible. They also addressed the issues associated with the use of the term “central sensitization syndrome” and the importance of primary care professionals understanding the impact of ANPE.

Rodríguez Ledo argued that patients should actively participate in improving healthcare and called for a form of medicine based on both clinical knowledge and active listening and understanding.

“Humanizing isn’t just about treating people well; it’s about believing them, listening to them, recognizing their limitations, and offering responses that are proportionate to their needs—even when we don’t yet have all the scientific answers we’d like,” he said.

Training and collaboration to advance the treatment of the disease

Through this initiative, SEMG reinforced its commitment to the continuing education of family physicians and to collaboration between healthcare professionals and patient associations to improve understanding of complex diseases such as myalgic encephalomyelitis.

The workshop highlighted the importance of integrating scientific evidence and clinical knowledge with the experiences of those affected in order to move toward more individualized care tailored to their needs.