The treatments applied for back problems include medical advice, pharmaceutical medication and a wide variety of non-pharmaceutical treatments.

Very few of the recommendations doctors have traditionally given patients with back pain have been evaluated scientifically. And, when they have been, some have been shown to be useless or even counterproductive, such as bed rest. The Foundation promotes the evaluation of medical advice by means of methods as rigorous as those applied to all other treatments. Thus, for example, it has made the first double-blinded clinical trial on the effect of the firmness of the mattress on back pain, showing that it has a very important effect on the evolution of the pain and that, as opposed to what is traditionally recommended, a medium firm mattress improves patients' evolution more than twice as much as a very firm mattress.

Law requires that the efficacy and safety of medications be evaluated before they are put on the market. However, the vast majority of corresponding studies are sponsored by the pharmaceutical laboratories, which are profit-making companies whose income depends on the results of these studies. For that reason, the Foundation is open to collaborating in these studies in order to ensure their desired impartiality. Additionally, evidence on the effect of certain medications on some patients who use them regularly is lacking; also lacking are studies that determine beyond the efficacy and safety of each medication individually, the effectiveness and efficiency of different pharmacological alternatives. For this reason, the Foundation is also open to making the necessary studies to optimize the effectiveness and efficiency of the pharmacological treatment used in patients with back pain.

A field in which scientific evidence is especially scarce is that of non-pharmaceutical treatments, such as electrotherapy or surgery. Thus, the Foundation makes analyses of the available scientific evidence on different non-pharmacological treatments such as electrotherapy and different surgical techniques. Its objective is to identify clearly those procedures which have been shown to be effective and safe and to define the cases in which their use is appropriate, in order to promote their use in those cases in which they are indicated and under the application conditions in which they have been shown to be valid. The Foundation also sets out to identify those which have been shown to have no positive effect, in order to recommend the suppression of the useless expense of their application. Additionally, the Foundation identifies those fields in which there are no studies, and those in which studies are needed urgently before continuing to expose the population to measures of dubious efficacy and safety.

The main social, economic and health problem are those patients with chronic pain without any indication for surgery. It is calculated that the 20% most chronic patients cause 80% of the costs generated by back ailments. Those patients with the worst prognoses from the medical point of view are those who suffer the greatest reduction in the quality of their life and who generate the highest health care and labor costs.

The Foundation develops treatments for these cases and evaluates their efficiency and effectiveness. Thus, in collaboration with the National Health System, the Foundation has carried out and co-financed studies on neuroreflexotherapy (NRT) for the treatment of sub-acute and chronic back ailments for which surgery is not indicated. First the efficacy and the safety of this technology were demonstrated and the results were repeated by a second, different, research team in a different geographic and clinical setting. Afterwards, its effect when applied under habitual care conditions was evaluated (effectiveness) as well as the economic impact (efficiency) that its use implied for the National Health System.

Thus it was shown that by adding this technology to the usual treatment of those patients in the System in specific application conditions, the patients' evolution improves between 3 and 8 times more, the costs are reduced by 75.3% and the efficiency of the public resources spent on their treatment increases between 6 and 22 times. Given these results, a pilot program was established to use this technology in the System under the conditions that had been evaluated to determine the degree of satisfaction it produced among patients and doctors and to collect the necessary information to make a rational planning of its implantation (how to quantify its demand in care and to determine the rate of its appropriate and inappropriate use). Finally, it was incorporated into the System under the conditions in which it had been shown to be effective, safe, and efficient, and the necessary mechanisms were established to evaluate on a consistent basis the outcome obtained through its use.The process followed with this technology is, in the Foundation's point of view, a good example of the system which would be desirable to follow on a customary basis in the implantation of new health technologies in the National Health System, in order to ensure the efficacy, safety and effectiveness of the treatments applied in it as well as the efficiency of the public resources allotted to financing it

Keeping in mind the enormous public expense that back disorders generate for the Public Health System, the Kovacs Foundation also studies the health and economic impact entailed in the application of different treatments. Thus, for example, it carries out community trials to evaluate the effectiveness of different treatment protocols in the management of patients with low back pain, both in the National Health System as well as in the environment of occupational accident and mutual insurance companies. These studies assess the impact of the different treatment strategies on the clinical evolution of patients and the costs they generate, both from the point of view of health care and labor.

http://www.kovacs.org/English/inv_medica/Dolor.asp

The most known Dr. and researcher in Spain in this field is Dr. Kovacs. This is his website:

http://www.kovacs.org/English/index.asp