ME/CFS & Long Covid: What's behind them?

Dr. Martina Melzer, published: 02/08/25

They are two chameleons of medicine: ME/CFS and post-Covid syndrome. There are probably as many different symptoms for both as there are causes and possible therapies. How can this be?

In short: they are (neuroimmunological) multisystem diseases.

More precisely: an infection or other stressor triggers an inflammation in the body. If everything does not proceed normally, this leads to an imbalance in the immune system with smouldering inflammation in the body and brain and sometimes also to autoimmune processes. This is accompanied by oxidative stress, malfunctions and disorders in the intestinal microbiome, the cardiovascular system and the inner walls of the blood vessels. There is also a lack of oxygen in the tissue and a disturbed energy metabolism - both in the brain and in body tissues.

There is a malfunction of the autonomic nervous system (dysautonomia) with an imbalance of the sympathetic and/or parasympathetic nervous system. The so-called stress axis initially releases too much stress hormones such as cortisol for too long (in order to contain the inflammation), which later leads to an exhausted cortisol release. If the immune system is impaired, this can lead to recurring infections and/or reactivation of pathogens that persist in the body (especially herpes viruses).

If a stressor disrupts the body's inner balance, all these processes can be set in motion. Temporary tissue damage can occur as part of the malfunction.

The energy deficiency that is so characteristic of ME/CFS and Long Covid is probably a result of a lack of oxygen in tissues that are needed during exercise (e.g. the muscles). This is probably initially followed by an increase in energy production as compensation and later a reduction, which leads to a hypometabolic state of the brain and periphery. A malfunction of the mitochondria can also be observed.

ME/CFS and post-Covid syndrome are considered by some scientists to be primarily a disorder of the brain (and nervous system) and by others primarily a disorder of the immune system.

The therapeutic focus is on disease management with pacing, medication and other potentially helpful procedures. It is assumed that no cure is possible.

In a nutshell, these are disorders of body-mind-brain interaction that can be explained by psychoneuroimmunology.

More precisely, mind-body medicine, as part of traditional conventional medicine, deals with the interactions between body, mind and brain. Psychoneuroimmunology describes what happens at a molecular level.

One (or more) stressors disrupt the inner balance (homeostasis), which leads to the imbalances in the immune system, the cardiovascular system, the hormone system, the autonomic nervous system and the energy metabolism described above. This also has an effect on the psyche. Psychoneuroimmunology assumes that all these systems are inextricably linked. Whatever disrupts one system disrupts them all (= mind-body syndrome). If the organism is in a chronic state of stress (= autonomic nervous system in survival mode), it can no longer establish homeostasis.

The therapeutic focus is on seeing the person as a whole. Attempts are made to find out which psychological and physical factors and stressors are disrupting the inner balance and how this can be restored. Healing is possible in principle.

In short: these are so-called neuroplastic diseases/disorders.

More precisely, neuroscience deals with the structure and functions of the brain and nervous system. In the case of chronic pain, many neuroscientists now assume that it is caused by neuroplasticity. In simple terms, neuroplasticity means that the brain can learn new things and unlearn old ones, it can adapt and change. In the case of chronic pain, the brain has learned to react to certain situations and stimuli with pain. It evaluates the stimuli and the pain as dangerous - even if everything is actually okay (again). This is why we speak of neuroplastic pain.

Some scientists have applied these findings to diseases such as ME/CFS and Long Covid. This is because the same regions of the brain are altered as in the case of pain. The changes in the body described above occur as a result of changes in the brain and nervous system that have been thrown out of balance by psychological and physical stressors. Some researchers focus primarily on neuroplasticity and conditioning (= learning mechanisms), while other scientists investigate the states in which the autonomic nervous system can exist (keyword: polyvagal theory, survival mode).

The therapeutic focus is on unlearning the learned old reactions to certain stimuli and situations and learning a new reaction. For example, the brain should learn that it no longer has to classify these things and symptoms as dangerous and that it no longer needs to trigger them via the autonomic nervous system. It is also important to recognize psychological and physical stressors and to bring the brain and nervous system back into a healthy balance. The person is considered as a whole with their life history. Healing is possible in principle.

Conclusion: ME / CFS and post-Covid syndrome = neuroimmunological multisystem diseases = dysautonomias = mind-body syndromes = neuroplastic disorders. As you can see, there are simply different perspectives and explanations for how all the dysfunctions and changes occur. And therefore different names and treatment approaches.

By the way: chronic does not mean forever. People recover from all kinds of illnesses - or at least significantly improve their condition.

Translated with DeepL

Important: The statements in this text are the result of my research from scientific studies, professional articles, books, courses, education and training as well as my own recovery process. I have done the best possible research, but nevertheless make no claim to accuracy. In science, something is considered a hypothesis until it is clearly proven (or disproven). That is then evidence, a fact. The statements in this text are a combination of hypotheses and facts.

Also, the content on this page is for informational purposes only and is not a substitute for talking to your doctor or other therapist. Please talk to your doctor or therapist before making any decisions about your physical or mental health. Every way into a mind-body syndrome is something individual, and every way out.