Phenotypes can help classify Chronic low back pain (CLBP) into nociceptive, neuropathic, and nociplastic types based on the underlying pain mechanisms. This categorization aids in identifying the main type of pain and tailoring treatments, including behavior change, pain education, medications, and psychosocial support. The Pain Stages of Change Questionnaire (PSOCQ) can assess a patient's readiness for self-management. Different pain phenotypes may show varying levels of readiness for change; however, it was not previously reported in the literature.

To identify differences in readiness for change between pain phenotypes in participants with CLBP.

This is a cross-sectional study that utilizes secondary data. The sample comprised participants with CLBP, both sexes, aged between 18 and 60 years, divided into subgroups by pain phenotype: nociceptive (G1), neuropathic (G2), nociplastic (G3) and mixed (G4). Participants answered the PSOCQ questionnaires to assess readiness for change covering four subscales (Precontemplation, Contemplation, Action and Maintenance), the score obtained is through a 5-point Likert scale, which ranges from "completely disagree" to "completely agree", and is calculated by averaging the responses, ranging from 1 to 5, Central Sensitization Inventory (CSI) 25 items and Pain Detect Questionnaire. For statistical analysis, one-way analysis of variance (ANOVA) was performed, followed by LSD post-hoc test (p < 0.05).

A total of 150 participants, G1= 48, G2= 59, G3 = 8, G4 = 35 (97 women and 53 men with mean, standard deviation [SD] age of 41.07, SD = 11.55 years; mean weight of 76.70, SD = 16.75 kg and height of 1.67, SD = 0.09 m) were recruited for this study. The ANOVA revealed a significant difference in the scores of the PSOCQ between pain phenotypes only for the Pre-contemplation domain (F(3, 146) = 2.89, p = 0.037). The neuropathic (mean[M] = 3.07) showed significant higher scores for the pre-contemplation domain of the PSOCQ when compared to nociceptive (M = 2.45, p = 0.02) and nociplastic subgroups (M = 2.55, p = 0.04). In addition, the mixed group (M = 2.77) also showed higher score for pre-contemplation domain than the nociceptive group (M = 2.45, p = 0.03).

The results suggest readiness for change is influenced for pain phenotypes particularly for the Precontemplation stage. Patients with neuropathic pain and mixed pain phenotypes showed less readiness to change beliefs than patients which pain is classified as nociceptive.

Understanding differences in readiness for change between pain phenotypes can assist physical therapists in adjusting their therapeutic methods. Patients with nociceptive pain profiles appear more willing to participate in active treatments such as exercise, where modifying lifestyle is part of the therapy. We encourage physical therapists to categorize patients based on their pain phenotype profiles.