England captain Ben Stokes is out of the first Test against Pakistan, with Durham seamer Brydon Carse in to make his debut.
Stokes, 33, has not played since the beginning of August, but England said 10 days ago he was "on track" to participate in this tour.
The all-rounder mainly trained apart from the rest of the squad before batting in the nets in Multan on Saturday, then confirmed he would miss the Test starting on Monday.
Ollie Pope, who led England during the 2-1 series defeat of Sri Lanka, will continue to deputise as captain.
"I tried my hardest to get myself fit for this game, but have taken the call to miss this one because I've not quite managed to get game-ready," Stokes told BBC Sport.
"There is a lot that has to go into my rehab programme. We got to a certain point, but looking at the picture of what we've got coming up and physically where I'm at, I'm not quite ready to play.
"It's always frustrating to miss out. I've got some good things to focus on, so even though I'm not playing I've got a goal in mind."
Stokes' attention will now turn to the second Test, also in Multan. In a tight tour of three back-to-back Tests, that match begins in 10 days, on 15 October.
Asked if that is a realistic goal, Stokes said he is "not sure".
"I've pushed myself incredibly hard and worked really hard with the medical team to get to where I'm at now. I think I'm further ahead than what we expected.
"I'll be working just as hard over the next 10 days to try to get myself fit for the second Test."
England XI for first Test against Pakistan: Zak Crawley, Ben Duckett, Ollie Pope (captain), Joe Root, Harry Brook, Jamie Smith, Chris Woakes, Gus Atkinson, Bryson Carse, Jack Leach, Shoaib Bashir.
Stokes had previously suggested that if he did return to the England side on this tour, it might be as a batter only.
On whether a potential return for the second Test may include bowling, he said: "That's too far away to say. There's a lot more things going into the next 10 days. We've got a good plan put together by myself and the medical guys.
"Bowling is in my 10-day plan from now until that next one, eking bowling back into all my training. Hopefully that goes well."
England once again cover for the lack of Stokes as an all-rounder with five frontline bowlers and wicketkeeper Jamie Smith batting at number six.
Carse makes his Test debut little more than a month after completing a three-month ban for historical gambling offences.
The 29-year-old was suspended in May for placing 303 bets on various cricket fixtures between 2017 and 2019, although none of those were on matches he played in.
Carse, who kept his two-year England central contract despite the ban, immediately returned to the national side for the white-ball series against Australia in September. Overall, the man born in Cape Town has played 19 one-day internationals and four T20s for England.
He is another bowler who possesses the high pace England covet and can provide valuable runs down the order, with two first-class hundreds to his name.
Carse gets the nod ahead of Durham team-mate Matthew Potts and Olly Stone, who will leave the tour during the first Test for his wedding in the UK next Saturday.
On Carse, England batter Joe Root told BBC Sport: "He's a natural wicket-taker. He's got those balls in him that out of nowhere can make something happen.
"It's really exciting when you've got someone like that, who can potentially turn the game on its head in a matter of moments. He's full of confidence off a decent series against Australia and it's good to have him out here."
Chris Woakes will bat at number seven in his first overseas Test for more than two years and his first in Asia since 2016. Along with Gus Atkinson, who has not before played a Test in Asia, it will be a considerable challenge for England’s pace bowlers in temperatures around 36C.
Zak Crawley returns to open the batting after missing the Sri Lanka series with a broken finger and there is also a recall for left-arm spinner Jack Leach, who was overlooked at the beginning of the home summer in favour of Shoaib Bashir. The Somerset team-mates will form a spin pairing.
Leach has been injured in each of the last two Tests he has played. Against India in Hyderabad earlier this year, the 33-year-old suffered a leg injury that put him out of the rest of the tour. At the start of the home summer in 2023, Leach hurt his back in the Test against Ireland at Lord's and subsequently missed the Ashes.
England won 3-0 on their last trip to Pakistan in 2022, the first time any visiting team had achieved such a clean sweep in this country.
That series is part of a 10-match winless run at home for Pakistan, who were beaten 2-0 by Bangladesh last month.