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SAX\u2010based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This single\u2010centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the \u2018None\u2019 and \u2018Severe\u2019 outcomes at M1 (cosine similarity 0.44) and M6 (cosine similarity 0.49). Stratifications of M6 outcomes by preoperative pain intensity, sex, age group, surgery type and catastrophising showed significant heterogeneity of pain transition patterns within and across strata. Severe\u2010to\u2010severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Clinically, these results suggest that individual pain\u2010state transitions, even within patient or procedural strata associated with PPP, may not alone offer good predictive information regarding PPP. Longitudinal observation in the immediate postoperative period and consideration of patient\u2010 and surgery\u2010specific factors may help indicate which patients are at increased risk of PPP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6\u00a0months after surgery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.1698","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T23:56:26Z","timestamp":1605052586000},"page":"624-636","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Predicting long\u2010term postsurgical pain by examining the evolution of acute pain"],"prefix":"10.1002","volume":"25","author":[{"given":"Cameron R.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Anesthesiology University of Florida College of Medicine Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raheleh","family":"Baharloo","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering University of Florida Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Nickerson","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering University of Florida Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Wallace","sequence":"additional","affiliation":[{"name":"Center for NeuroGenetics University of Florida Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baiming","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Biostatistics College of Public Health and Health Professions University of Florida Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger B.","family":"Fillingim","sequence":"additional","affiliation":[{"name":"Pain Research and Intervention Center of Excellence University of Florida Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Crispen","sequence":"additional","affiliation":[{"name":"Department of Urology University of Florida College of Medicine Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hari","family":"Parvataneni","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation University of Florida College of Medicine Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chancellor","family":"Gray","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation University of Florida College of Medicine Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hernan","family":"Prieto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation University of Florida College of Medicine Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Machuca","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Florida College of Medicine Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Florida College of Medicine Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Murad","sequence":"additional","affiliation":[{"name":"Lillian S. 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