Chronic pain during 60 days of war: the impact of the Russian war on Ukrainian patients

The Russian invasion of Ukraine provided a natural experiment of the impact of war exposure on pain experience. We hypothesized that longer exposure to direct combat (e.g., ground war) would be associated with greater increases in chronic pain than shorter duration direct combat exposure and indirect combat exposure (e.g., airstrikes only).

This is a prospective cohort study surveying Ukrainian patients with chronic pain (N = 336) seen at an academic medical center in Ukraine within 2 weeks prior to the onset of the war on February 24, 2022. Data were obtained at baseline, and 2, 4, and 8 weeks later. Patients sustained no war-related injuries. Patients were grouped into one of three exposure groups: patients who were exposed to ground war for 2 months (group 1); patients who were exposed to ground war for 1 month (group 2), and patients exposed to airstrikes only but no ground war (group 3).

Groups 1 and 2 reported a 2.4-fold increase in pain from baseline levels 2 weeks into the war, whereas group 3 reported a 2.1-fold increase in pain at 2 weeks. A similar pattern emerged for PHQ-9 depression scores, with groups 1 and 2 showing steeper increases in depression scores by 1 month after the onset of war than group 3. Increased depression mediated the effect of combat exposure on pain scores.

Chronic pain levels increased with extent of environmental exposure to direct combat. Elevated depression symptoms may account for some of the observed increase in pain.