The Total Pain in Ukraine Study: How Does War Affect Civilians With a History of Chronic Pain? An Observational Study

ABSTRACT Background Chronic pain is common and can burden individuals, families and society. This exploratory study conducted in response to the full‐scale war in Ukraine from February 2022 aimed to assess the impact of war‐related distress on civilians living with chronic pain. Methods Participants were asked to fill in an online questionnaire evaluating pain diagnoses, pain characteristics, analgesic use, screening for anxiety and depression. Results The cohort comprised individuals receiving care in five chronic pain centres in Ukraine before February 2022. Between December 2022 and March 2023, 952 participants accessed the survey, with data from 833 qualifying for analysis. Men represented 64% ( n = 533) of the cohort; 55% of the cohort ( n = 455) were aged 21–40 years; 61% reported indirect exposure to the war. The majority (80%) had received some form of psychological support before February 2022. For most (72%), economic status worsened since the onset of the war. Alcohol consumption increased in 44% of the cohort. At the time of the survey, 40% reported pain intensity scores of 0–3/10, 26% scored intensities of 4–6/10 and 34% scored intensities of ≥ 7/10; 41% described their pain as ‘distressing’ or ‘horrible’. Most participants met criteria for clinically relevant anxiety (71%) and depression (82%). Conclusions In this cohort, pain severity before the war is unknown; however, 70% reported moderate to severe pain at evaluation. Combined with high rates of anxiety and depression, these findings highlight significant distress among Ukrainians with chronic pain and the need for sustained, individualised pain and psychological support. Significance Statement We assessed the impact of war on civilians with chronic pain in Ukraine. An online survey completed by 833 patients from five clinics explored bio‐psycho‐social pain aspects. Most were men aged 21–40 with indirect war exposure. Economic hardship was common, and half reported increased alcohol use. Moderate to severe pain affected 59%; 41% found it distressing or horrible. Anxiety and depression were prevalent. Findings highlight major gaps in care, stressing the need for personalised pain management and integrated psychological support.