Introduction
CNLBP, anxiety, epilepsy, back pain, pain, Low back pain, disability, leg pain, depression, pain-insomnia, LBP, pain-related disability
CHRONIC PAIN, HEAT, DISORDERS, EPILEPSY
Low back pain (LBP) is the world's most prevalent and disabling condition and is generally classified according to the duration of pain in acute (<6 weeks), subacute (6-12 weeks), and chronic (>12 weeks) (Data related to LBP have predominantly been published in high-income countries (A specific cause of LBP is rarely identified (pain and other symptoms caused by specific pathophysiological mechanisms of nonspinal or spinal origin); hence, most LBPs are termed nonspecific (back pain [with or without leg pain] without a clear nociceptive specific cause). CNLBP has physical risk factors, such as prolonged standing or walking, lifting heavy weights, and psychological factors, such as depression and job dissatisfaction. High levels of depression or anxiety are consistently associated with poor outcomes (i.e., ongoing pain and/or disability) in patients with LBP (Recently, studies have reported that comorbidities of depression-anxiety-chronic pain-insomnia by neurosensitization processes are similar to those of epilepsy, in which a persistent increase in neuronal reactivity occurs. Neurosensitization is the basis of a common etiology of chronic pain, depression, and anxiety disorders and can cause clinical manifestations to be increasingly spontaneous, persistent, and severe (According to the existing literature, non-pharmacological treatment of CNLBP involves interventions to help people manage health conditions effectively and maintain quality of life because it is a potential strategy to reduce pain-related disability (self-management support) (Pilates and segmental stabilization of the spine aim to activate the deep and stabilizing muscles of the trunk, that is, muscles directly connected to the vertebrae and responsible for segmental spinal control, to stabilize the trunk and limb movements, thus positively impacting the management of CNLBP (A network meta-analysis by Hayden et al. (Therapeutic heat has also been used as a non-pharmacological treatment to decrease pain in patients (The generation of intense heat in the body activates transient receptor potential vanilloid (TRPV1) receptors, which are abundantly expressed in the limbic system and the systemic nuclei involved in emotion management (Other studies have also suggested that active SWD associated with an exercise program is effective for CNLBP (A recent systematic review on the use of SWD in chronic LBP revealed that studies lacked content; additionally, existing studies have low methodological quality with undeclared study designs and inadequate descriptions of the parameters used. The authors of the systematic review also pointed to the need for new randomized clinical trials on this subject with a special focus on detailing the prescription parameters and methodological rigor used in SWD (Therefore, this study aimed to evaluate the effect of the association between CSWD and Pilates on reducing pain, depression, and anxiety in patients with CNLBP. We hypothesized that this association is beneficial for decreasing pain, depression, and anxiety in these patients.