Cameron R Smith1, Raheleh Baharloo2, Paul Nickerson3, Margaret Wallace4, Baiming Zou5, Roger B Fillingim6, Paul Crispen7, Hari Parvataneni8, Chancellor Gray8, Hernan Prieto8, Tiago Machuca9, Steven Hughes9, Gregory Murad10, Parisa Rashidi2,3, Patrick J Tighe1. 1. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA. 2. Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA. 3. Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA. 4. Center for NeuroGenetics, University of Florida, Gainesville, FL, USA. 5. Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA. 6. Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA. 7. Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA. 8. Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA. 9. Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. 10. Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA.
Abstract
BACKGROUND: Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage. METHODS: We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX-based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other. RESULTS: This single-centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the 'None' and 'Severe' 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-to-severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6. CONCLUSIONS: Clinically, these results suggest that individual pain-state 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- and surgery-specific factors may help indicate which patients are at increased risk of PPP. SIGNIFICANCE: Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.
BACKGROUND: Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage. METHODS: We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX-based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other. RESULTS: This single-centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the 'None' and 'Severe' 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-to-severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6. CONCLUSIONS: Clinically, these results suggest that individual pain-state 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- and surgery-specific factors may help indicate which patients are at increased risk of PPP. SIGNIFICANCE: Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.
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