Why an Integrative Approach Is Needed For Chronic Fatigue Syndrome and
Fibromyalgia
DR. SURUCHI CHANDRA | NEUROTHERAPy
BETHESDA, MARYLAND I WASHINGTON DC
- Naviaux RK. (2020) — Biology of the Cell Danger Response https://pubmed.ncbi.nlm.nih.gov/32074847/Naviaux RK. (2014) — Metabolic Features of the Cell Danger Response https://www.sciencedirect.com/science/article/pii/S0006291X1400352X
- Hopkins Medicine — Chronic Fatigue Syndrome
https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-fatigue-syndrome - Myhill et al. (2009) — Chronic Fatigue Syndrome and Mitochondrial Dysfunction
https://pmc.ncbi.nlm.nih.gov/articles/PMC2680051/ - Anderson et al. (2020) — Mitochondria, Immunity, and ME/CFS
https://www.sciencedirect.com/science/article/abs/pii/S1568997220301075 - Johns Hopkins Lyme Research Center — Lyme Disease Is Not Psychosomatic
https://www.hopkinslyme.org/lyme-disease-awareness/research-substantiates-lyme-disease-is-not-a-psychosomatic-illness/
Articles & Resources
About Dr. Chandra
Dr. Suruchi Chandra, a Harvard- and Yale-trained psychiatrist, brings together emerging neuroscience-based therapies, trauma-informed care, nutritional approaches, and systems-level biology to advance thinking in psychiatry and help more patients find clearer paths forward.
See full bio.
Next Steps
Chronic fatigue syndrome and fibromyalgia are not imaginary, psychological, or untreatable conditions. They are complex medical illnesses rooted in biology, often triggered by infection and sustained by system-level dysregulation.
Understanding why the body feels sick is a critical first step toward more effective and compassionate care.
Serving patients in Bethesda, Maryland, Washington DC, and Northern Virginia.
Medically reviewed by Suruchi Chandra, MD. This content is for educational purposes only and does not substitute for individualized medical advice.
Updated February 2026
Understanding why the body feels sick is a critical first step toward more effective and compassionate care.
Serving patients in Bethesda, Maryland, Washington DC, and Northern Virginia.
- Learn more about Integrative Approaches to Chronic Fatigue
- New patient information
- About Dr. Chandra
- Visit Dr. Chandra's blog
Medically reviewed by Suruchi Chandra, MD. This content is for educational purposes only and does not substitute for individualized medical advice.
Updated February 2026
Why Our Clinic’s Approach to Chronic Fatigue and Fibromyalgia Is Different
Dr. Suruchi Chandra is a psychiatrist with specialized training in neuroimmune conditions and extensive experience working with patients who have chronic fatigue syndrome and fibromyalgia.
Our clinic’s approach combines:
In addition to integrative medical evaluation, we also offer neurotherapy, which is addressed in a separate article focused specifically on nervous system regulation in chronic fatigue and fibromyalgia.
Our goal is not quick fixes, but helping patients who have not fully responded to standard care regain stability, resilience, and quality of life.
Our clinic’s approach combines:
- Integrative medical care focused on root causes, including chronic infections and immune dysregulation
- Expertise in brain-body signaling and stress physiology
- A collaborative, systems-based model rather than symptom silos
In addition to integrative medical evaluation, we also offer neurotherapy, which is addressed in a separate article focused specifically on nervous system regulation in chronic fatigue and fibromyalgia.
Our goal is not quick fixes, but helping patients who have not fully responded to standard care regain stability, resilience, and quality of life.
Chronic Fatigue and Mitochondrial Dysfunction: Why Energy Does Not Return With Rest
Mitochondria are responsible for producing cellular energy (ATP). In chronic fatigue syndrome and fibromyalgia, multiple studies have identified abnormalities in mitochondrial function and energy metabolism.
When mitochondria cannot efficiently generate energy:
This helps explain post-exertional malaise, a hallmark of chronic fatigue syndrome, where symptoms worsen after activity rather than improving. For patients, the experience is not deconditioning — it is a biological inability to meet energy demands.
When mitochondria cannot efficiently generate energy:
- Even small physical or cognitive tasks feel overwhelming
- Recovery after exertion is delayed or incomplete
- Rest does not restore function
This helps explain post-exertional malaise, a hallmark of chronic fatigue syndrome, where symptoms worsen after activity rather than improving. For patients, the experience is not deconditioning — it is a biological inability to meet energy demands.
Chronic Fatigue, Fibromyalgia, and Ongoing Immune Activation
Chronic fatigue and fibromyalgia are frequently associated with immune dysregulation rather than classic autoimmune disease. Patients may not have obvious inflammatory markers, yet immune signaling remains altered.
Persistent immune activation can:
At our clinic, one area of specialization is identifying and addressing difficult-to-detect chronic infections that may perpetuate immune activation when standard testing has been unrevealing.
Persistent immune activation can:
- Produce flu-like symptoms
- Amplify pain signaling
- Contribute to cognitive dysfunction
- Interfere with sleep and stress recovery
At our clinic, one area of specialization is identifying and addressing difficult-to-detect chronic infections that may perpetuate immune activation when standard testing has been unrevealing.
Chronic Fatigue, Fibromyalgia, and the Stress Response System (HPA Axis)
The hypothalamic-pituitary-adrenal (HPA) axis coordinates how the body responds to stress. In chronic illness, this system often becomes dysregulated.
For patients with chronic fatigue or fibromyalgia, HPA axis dysfunction can mean:
This is not “stress causing illness,” but rather a stress response system altered by prolonged immune and metabolic strain. Addressing this requires medical understanding of both neurobiology and systemic illness.
For patients with chronic fatigue or fibromyalgia, HPA axis dysfunction can mean:
- Poor tolerance for physical or emotional stress
- Sleep disruption
- Worsening symptoms after stress rather than resilience
This is not “stress causing illness,” but rather a stress response system altered by prolonged immune and metabolic strain. Addressing this requires medical understanding of both neurobiology and systemic illness.
Chronic Fatigue, Fibromyalgia, and the Cell Danger Response
One framework that helps integrate these findings is the Cell Danger Response (CDR), described by Naviaux and colleagues.
The cell danger response is a protective metabolic state that cells enter in response to threat — such as infection, inflammation, or toxic stress. When activated, cells shift priorities away from growth and repair toward defense and survival. Healing cannot fully resume until this response resolves.
In chronic fatigue syndrome and fibromyalgia, research suggests that the cell danger response may remain incompletely shut off, even after the original trigger has passed. When this occurs:
For patients, this translates into persistent fatigue, post-exertional crashes, pain, and heightened sensitivity. Importantly, this is a biological survival response, not a psychological failure.
The cell danger response is a protective metabolic state that cells enter in response to threat — such as infection, inflammation, or toxic stress. When activated, cells shift priorities away from growth and repair toward defense and survival. Healing cannot fully resume until this response resolves.
In chronic fatigue syndrome and fibromyalgia, research suggests that the cell danger response may remain incompletely shut off, even after the original trigger has passed. When this occurs:
- Energy production is downregulated
- Immune signaling remains heightened
- Pain sensitivity increases
- Normal recovery mechanisms are impaired
For patients, this translates into persistent fatigue, post-exertional crashes, pain, and heightened sensitivity. Importantly, this is a biological survival response, not a psychological failure.
Chronic Fatigue, Fibromyalgia, and Gut-Immune-Brain Signaling
The gut plays a central role in immune regulation and communication with the brain. In chronic fatigue and fibromyalgia, disturbances in gut integrity or microbiome balance can amplify inflammation and immune signaling.
For patients, this often appears as:
An integrative approach considers how gut health influences immune tone, energy metabolism, and nervous system regulation.
For patients, this often appears as:
- Digestive symptoms alongside fatigue
- Food sensitivities
- Worsening systemic symptoms tied to gut stress
An integrative approach considers how gut health influences immune tone, energy metabolism, and nervous system regulation.
Why an Integrative Medical Approach Is Needed for Chronic Fatigue and Fibromyalgia
Because chronic fatigue syndrome and fibromyalgia involve interacting systems, single-target treatments often provide only partial relief. Treating pain alone, mood alone, or sleep alone misses the larger biological picture.
An integrative approach focuses on:
This is not alternative medicine — it is systems-based medicine.
An integrative approach focuses on:
- Identifying root contributors rather than isolated symptoms
- Understanding how immune, metabolic, and stress systems interact
- Supporting the body’s ability to exit survival mode gradually and safely
This is not alternative medicine — it is systems-based medicine.
Chronic Fatigue and Fibromyalgia Are Often Post-Infectious Illnesses
Many patients trace the onset of chronic fatigue or fibromyalgia to a clear biological event, such as:
In these cases, the body does not fully return to baseline after the initial illness. Instead, immune signaling remains altered, leading to persistent symptoms such as exhaustion, pain, cognitive fog, and a sense of being “sick without being sick.”
This helps explain why patients with chronic fatigue and fibromyalgia often feel as though they are constantly coming down with the flu — because their immune system is still behaving as if a threat is present.
- A viral illness (e.g., EBV, COVID, influenza)
- A bacterial infection (including Lyme and other tick-borne infections)
- A period of intense immune or inflammatory stress
In these cases, the body does not fully return to baseline after the initial illness. Instead, immune signaling remains altered, leading to persistent symptoms such as exhaustion, pain, cognitive fog, and a sense of being “sick without being sick.”
This helps explain why patients with chronic fatigue and fibromyalgia often feel as though they are constantly coming down with the flu — because their immune system is still behaving as if a threat is present.
Patients with chronic fatigue syndrome (ME/CFS) and fibromyalgia often describe the same experience: feeling persistently sick, inflamed, depleted, and flu-like — sometimes for years. Many are told their labs are normal, that stress is the cause, or that nothing more can be done.
Modern research increasingly supports what patients have long known. Chronic fatigue syndrome and fibromyalgia are real medical conditions, often involving immune activation, post-infectious processes, and disruptions in how the body produces energy and regulates stress. These conditions are complex, and for many patients, standard single-system care has not been sufficient.
This article explains why these illnesses feel the way they do and why an integrative medical approach is often necessary.
Modern research increasingly supports what patients have long known. Chronic fatigue syndrome and fibromyalgia are real medical conditions, often involving immune activation, post-infectious processes, and disruptions in how the body produces energy and regulates stress. These conditions are complex, and for many patients, standard single-system care has not been sufficient.
This article explains why these illnesses feel the way they do and why an integrative medical approach is often necessary.
Why These Are Real Medical Conditions — and Why an Integrative Approach Matters
