This is a screening form for our current Complex Regional Pain Syndrome studies.

We are studying two new pain treatments. You may be asked to come to up to 5 sessions, answer daily questions, and complete questionnaires.

The screening questions should take about 15 minutes to complete.
This will help us understand if you may be eligible for one of these specific studies.

Please be assured that your information will be stored SECURELY and NOT SHARED with any third party.

You can choose if you want or do not want to take part in this research screening procedure - it is up to you. If you refuse to answer the questions or stop answering them at any time, there will be no penalty, and you will not lose any benefits to which you otherwise would be entitled.

If you have any questions, concerns, or complaints about this form, contact Protocol Director, Sean Mackey, MD, PhD, at (650) 725-9636.

If you want to talk to someone separate from the research team about a concern or complaint or your rights as a possible research subject, please contact the Stanford Institutional Review Board (IRB) to speak to an informed person who is separate from the research team, at 650-723-5244 or toll-free at 1-866-680-2906.

Thank you for your participation!

Page 1 of 27

Loading... Loading...
You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.
The response has now been removed for the last question for which you selected a value. You may now enter a new response for that question and continue the survey.