Comparative Effectiveness of Myofascial Release vs Graded Motor Imagery and Desensitization Exercise Therapy in Managing Complex Regional Pain Syndrome (CRPS) in Pediatric Burn Survivors: A Randomized Controlled Trial

Abstract

Background: Complex Regional Pain Syndrome (CRPS) is a chronic, neuropathic pain condition that may develop following tissue trauma such as burns, characterized by disproportionate pain, sensory disturbances, and motor dysfunction. Pediatric burn survivors are particularly vulnerable due to heightened inflammatory and neuroplastic responses that contribute to maladaptive cortical reorganization and central sensitization. Traditional pharmacological management often yields suboptimal outcomes, prompting interest in non-pharmacological approaches targeting neuromuscular and sensory recovery. Objective: This study aimed to compare the effectiveness of Myofascial Release (MFR), Graded Motor Imagery (GMI), and Desensitization Exercise Therapy (DET) in improving pain intensity, functional mobility, and sensory hypersensitivity among pediatric burn survivors diagnosed with CRPS. Methods: A single-blind randomized controlled trial was conducted on 90 pediatric burn survivors aged 6–18 years diagnosed with CRPS. Participants were randomly assigned to MFR, GMI, or DET groups (n=30 each) for six weeks of intervention, comprising two sessions per week. Outcome measures included pain intensity (Visual Analog Scale), functional mobility (Timed Up and Go test), and sensory hypersensitivity (Quantitative Sensory Testing). Data were analyzed using one-way and repeated-measures ANOVA with Bonferroni post hoc tests and effect size estimation (η²). Results: All interventions significantly improved pain, mobility, and sensory function (p<0.001). The GMI group exhibited the largest reductions in pain (ΔVAS −4.1, p<0.001) and mobility time (ΔTUG −5.1s, p<0.001), while the DET group showed the greatest improvement in sensory thresholds (+1.5°C, p<0.01). Effect sizes indicated strong treatment effects (η² = 0.18–0.20). No adverse events were reported. Conclusion: MFR, GMI, and DET each demonstrated efficacy in managing CRPS in pediatric burn survivors, with GMI showing superior outcomes in pain and mobility, and DET excelling in sensory desensitization. A multimodal rehabilitation approach integrating these techniques may offer optimal functional recovery.