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Chronic Pain Research

Returning?

A A A

Thank you for your interest in joining our study!

Please answer the questions in this short survey to help us see if you are eligible. We will reach out to you soon with details and to see if you are interested to join our study.

Your answers will not impact your medical care. All of your information will be stored securely at Duke University and seen only by trained study staff.

An information sheet will be sent to your email after you complete the survey. Please review it and contact us with any questions.

You can delete your record at any time by contacting us at (919) 684-2758 or ChronicPainResearch@duke.edu.

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Are you age 18 or older?

* must provide value

Yes

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Email Address

* must provide value

First Name

* must provide value

Last Name

* must provide value

Phone Number

* must provide value

Would you be able to travel to Duke University Hospital for an in-person study visit?

Yes

Maybe

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If maybe, please explain:

Date of Birth

Sex

If other, please describe:

What is your height?

What is your weight?

Do you currently suffer from pain on a regular basis?

Yes

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Where is your pain located?
Please select regions where you have felt persistent or recurrent pain present for the last 3 months or longer (chronic pain).

No Chronic Pain

Face

Right Jaw

Left Jaw

Head

Neck

Right Chest/Breast

Left Chest/Breast

Right Shoulder

Left Shoulder

Right Upper Arm

Left Upper Arm

Upper Back

Lower Back

Right Elbow

Left Elbow

Right Lower Arm

Left Lower Arm

Right Wrist/Hand

Left Wrist/Hand

Abdomen

Pelvis

Right Hip

Left Hip

Right Groin

Left Groin

Right Buttocks

Left Buttocks

Right Upper Leg

Left Upper Leg

Right Knee

Left Knee

Right Lower Leg

Left Lower Leg

Right Foot/Ankle

Left Foot/Ankle

Do any of these conditions apply to you?
(check all that apply)

No Chronic Pain (healthy volunteer)

Post-surgical/Surgery Recovery

Fibromyalgia

Chronic Low Back Pain

Complex Regional Pain Syndrome (CRPS or RSD)

Pelvic Pain

Migraine

Temporomandibular Joint Dysfunction (TMJ)

Irritable Bowel Syndrome (IBS)

Chronic Fatigue Syndrome (CFS)

Arthritis

Lupus

Other

If other, please describe:

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Do you have an ongoing disability claim?

Yes

I'm not sure

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Over the past 2 weeks, on a scale from 0 - 10, what was your AVERAGE amount of pain?

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Are you currently taking any medications?

Yes

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Do you take any opioid medications?

Yes

I'm not sure

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Please list any medications that you are currently taking.

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Are you claustrophobic (afraid of dark, enclosed spaces)?

Yes

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How did you hear about us?

Duke Pain Clinic

Other Clinic

Our Website

Google or Web Search

ResearchMatch

Craigslist

Flyer

Banner

Twitter

Facebook

Instagram

StumbleUpon.com

Newspaper

Radio

Duke List

Word of Mouth (i.e. referred by friend/family/colleague)

Other

If other, please specify:

Would you like to be notified of other studies and developments in the Pain Lab that may be of interest to you?

Yes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.