Low Dose Naltrexone for the
Treatment
of Fibromyalgia
Screening
The purpose of this screening interview is to see if you meet the criteria for taking part in our research study of the use of the medication low-dose naltrexone for Fibromyalgia.
This screening questionnaire asks you a list of questions. You may choose not to answer these questions. You also may choose to stop filling out the questionnaire at any time; there is no penalty for not answering these questions and you will not lose any benefits to which you otherwise would be entitled. Information from this questionnaire will be kept as confidential as possible as required by law. It is possible that the Food and Drug Administration, and other federal and state authorities, may inspect this record.
The risk to taking part in this interview is very small. A member of our research team will review your information and contact you to tell you more about the study and see if you are interested in taking part. If you decide not to participate, we will destroy your information.
There are no benefits to you to answering these screening questions. However, it is possible that the information from the study that we will be doing may help researchers to learn more about chronic pain and may benefit others in the future.
If you do not want to answer these questions, you have other choices. You can talk to your doctor about medications that may alleviate chronic pain, or you may want to continue with your current course of care.
If you have any questions, concerns, or complaints about this interview, contact Dr. Jarred Younger at 650-724-8783. 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. In addition, please call the Stanford IRB at these numbers if you cannot reach the research team.
This study is being funded by the non-profit organization: the American Fibromyalgia Syndrome Association (AFSA). There are no pharmaceutical industry or business interests involved in this study.
COMPLETE THE SCREENING QUESTIONNAIRE
