EP183 The pain portrait of war: chronic suffering and neuropathic syndromes in wounded soldiers attending a military outpatient pain management office

<h3>Background and Aims</h3> Combat injuries often lead to persistent pain, underrecognized in standard care. This study assessed pain characteristics and impact among wounded Ukrainian servicemen referred to a military outpatient pain management office. Focus was on neuropathic and phantom pain, and functional consequences. <h3>Methods</h3> This retrospective review used records from the outpatient pain management office. All patients were wounded Ukrainian soldiers treated between April 2024, and May 2025, for unresolved painStandardized tools included pain diagrams, the Visual Analogue Scale (VAS), and the DN4 questionnaire. <h3>Results</h3> A total of 96 unique patients underwent 154 consultations. Chronic pain was reported in 71.2% of cases, phantom limb pain in 23.7%. Neuropathic pain (DN4 ≥ 4) was present in 75.8% of cases, with a mean DN4 score of 4.89 ± 2.78. Pain mechanisms included neuropathic (81.4%), nociceptive (10.2%), and mixed or unspecified types. No statistically significant differences in pain intensity (VAS) were found between pain types (p = 0.48). The distribution of average pain intensity scores is shown in figure 1; the mean VAS score was 5.74 with a standard deviation of 2.17. DN4 scores by pain type, amputation status, and number of surgeries are summarized in figure 2. There was no significant difference in DN4 scores between patients with and without phantom limb pain. The time elapsed from injury to first consultation varied widely (figure 3). Functional impairment was notable: 78% reported limitations in daily activities and 55.9% experienced sleep disturbance. <h3>Conclusions</h3> Outpatient pain consultations for wounded soldiers reveal a high prevalence of chronic and neuropathic pain, significantly affecting daily activity and sleep. Despite severe trauma, pain mechanisms vary, and subjective intensity does not correlate with DN4 or pain type. Formalized protocols and early structured pain assessment improve diagnosis and treatment. Dedicated outpatient pain services are essential to address complex post-combat pain syndromes within military healthcare systems.