Clinical Trial for Back Pain | Spinal Cord Stimulator Survey

Clinical trials are research investigations in which people volunteer to test new treatments as a means to manage medical conditions. This helps to determine if a new treatment works, if it is safe, and if it is better than the treatments that are already available.

We are currently recruiting participants for a clinical trial for people living with CHRONIC LOW BACK PAIN with/without LEG PAIN.

This trial involves the use of an investigational Spinal Cord Stimulator (SCS) which requires a Day Surgery procedure to insert. The investigational device would be active for approximately 15 days. You would attend our clinic regularly during the active period to see our doctors and clinical team. At the end of the active period, the device is removed in the clinic.

This clinical trial includes research centres who are specialists in pain management, located in Newcastle NSW, Adelaide SA and Melbourne VIC.

Please complete the questions below to find out more information and if you may be eligible for this study. Potentially eligible participants will be contacted via phone to undergo further discussion about the study.

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* 1. Please add your details so we can contact you about the study:

Name

Email Address

Phone Number

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* 2. Please enter your date of birth (DD/MM/YYYY)

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* 3. If you know your approximate height & weight, please enter below:

Height (cms)

Weight (Kg)

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* 4. Are you currently pregnant or planning a pregnancy?

Yes

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* 5. How would you rate your average pain over the last week? (specifically related to back and/or leg pain)

None

Mild

Moderate

Severe

Extreme

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* 6. Have you been living with back and/or leg pain for more than 3 months?

Yes

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* 7. Where is your pain located?

Lower back

Leg/s only

Both back and leg pain

I do not have low back or leg pain

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* 8. Please indicate your average pain in your upper body areas only (neck, arms, shoulders, or upper back):

No pain in these areas

Mild

Moderate

Severe

Extreme

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* 9. Would you consider a minor surgical procedure for your back and/or leg pain?

Yes

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* 10. From the selections below, please indicated the treatments you have tried for your pain:

Oral Medication

Physiotherapy

Steroid Injection

Anaesthetic Block

Discectomy

Laminectomy

Spinal Fusion

Spinal Cord Stimulator (previous or current trial / implant)

Other (please specify)

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* 11. Have you been diagnosed with or experienced any of the below?

Cancer

Uncontrolled psychological condition (e.g.: depression, anxiety, schizophrenia)

Fibromyalgia

Spinal Stenosis

Any implanted electronic device (e.g. pacemaker)

None

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* 12. Please select the site nearest to you:

Newcastle, NSW

Melbourne, VIC

Adelaide , SA

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* 13. Please add your approximate travel time from your home to the selected site above:

Less than 45 minutes

45 - 90 minutes

90 minutes - 2 hours

More than 2 hours

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* 14. Please add your postcode below (optional)

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* 15. Are you available and willing to attend the selected site up to 8 times in a 2 month period for the clinical trial visits?

Yes

By completing this form you agree to be added to the Genesis Research Services database. Your privacy is important to us and your information will not be passed on to any third parties.