Discussion
CNLBP, Anxiety, anxiety, pain, depressive symptoms, depression
HEAT
This study aimed to evaluate the effect of the association between CSWD and Pilates on reducing pain, depression, and anxiety in individuals with CNLBP. However, we found no statistically significant difference between the evaluated groups, and both groups improved at follow-up, with the exception of the anxiety variable, which returned to pre-treatment levels in this assessment.Our study assumed that the association between Pilates and a form of vigorous heat (CSWD) could benefit patients in aspects related to pain, depression, and anxiety, as intense heat activates TRPV1 receptors, which are present in the brain regions involved in emotions, such as depression and anxiety.The role of heat in improving depressive symptoms is not yet fully understood, but studies on capsaicin, which also stimulates TRPV1 receptors, have shown that it acts as an agonist of the antidepressant effects associated with amitriptyline (As the analyzed variables did not show additional improvement in CNLBP treatment with the use of CSWD, it seems that performing Pilates is sufficient to control pain, depression, and anxiety. Karasel et al. (Anxiety symptoms are another important aspect to be improved in patients with CNLBP. Hu et al. (Our study also revealed that the application of CSWD had no significant effect on anxiety improvement. Additionally, we found that patients in both groups had moderate anxiety at the beginning of treatment, which changed to mild anxiety at the sixth week of treatment. After the 3-month follow-up, both groups returned to moderate anxiety levels, demonstrating that they managed to reduce anxiety levels only while receiving treatment.In a systematic review, Chong et al. (Finally, our study corroborates the systematic review conducted by Lemieux et al. (