Proposed Conditions for Pain Reprocessing Therapy Readiness: Beyond Phenotyping Neuroplastic Pain.

PURPOSE: This paper examines the clinical gap between identifying neuroplastic pain and achieving treatment success with Pain Reprocessing Therapy (PRT), proposing a structured readiness framework to guide clinicians in determining when patients are appropriately positioned to engage with this intervention for chronic primary pain.

RECENT FINDINGS: Despite a randomized controlled trial demonstrating that approximately 66% of PRT participants achieved pain-free or nearly pain-free status at one year, no implementation guidelines exist for establishing patient readiness prior to initiating treatment. This paper proposes ten conditions across four domains: patient cognitive readiness, patient behavioral readiness, provider alignment, and system-level factors. Evidence from pain neuroscience education, the fear-avoidance model, stages of change literature, and therapeutic alliance research supports the theoretical grounding of each condition. Emotional Awareness and Expression Therapy is proposed as an adjunctive intervention for patients whose pain is sustained by unresolved trauma or emotional inhibition beyond the reach of cognitive reattribution alone. Neuroplastic pain identification is necessary but may be insufficient for PRT success. Unmet readiness conditions spanning cognition, behavior, provider practice, and healthcare systems may explain a meaningful proportion of limited treatment responses. These proposals require empirical validation before clinical adoption and should be treated as hypotheses to guide implementation research rather than established practice guidelines.