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Topic:Pain Management
Pain management in horses involves various strategies and interventions designed to alleviate discomfort and improve the well-being of equine patients. It encompasses pharmacological approaches, such as the use of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and other analgesics, as well as non-pharmacological methods like physical therapy, acupuncture, and environmental modifications. Effective pain management aims to address both acute and chronic pain conditions, which can result from injuries, surgeries, or diseases such as laminitis and arthritis. This page aggregates peer-reviewed research studies and scholarly articles that explore the mechanisms, efficacy, and safety of different pain management techniques in horses, contributing to the understanding and advancement of equine veterinary care.
Use of a caudal intercostal block in horses undergoing surgery for colic. In humans and companion animals, regional anaesthesia is used in multimodal analgesic protocols for abdominal wall surgery. Benefits include earlier patient mobilisation and improved pain scores. Regional anaesthetic techniques for horses undergoing abdominal surgery could provide similar benefits and warrant investigation. Objective: To evaluate the safety and efficacy of a caudal intercostal block for abdominal surgery (CIBAS) in horses undergoing surgery for colic. Methods: Blinded, randomised clinical trial. Methods: Horses (n = 22) undergoing exploratory celiotomy for colic were rando...
Anatomy and Ultrasound-Guided Injection of the Deep Branch of the Lateral Palmar Nerve in the Horse: A Cadaveric Study. Proximal suspensory ligament (PSL) injuries are a common cause of lameness in horses. Localization of pain in the proximal metacarpal and carpal region remains challenging. Current diagnostic analgesic techniques are not PSL-specific. The aim of this study was to investigate the nerve supply of the PSL, with particular focus on the deep branch of the lateral palmar nerve (DBLPaN), and to develop a landmark-based, ultrasound-guided injection technique targeting this nerve. Unassigned: Eighteen limbs from euthanized horses were dissected to describe the anatomy of the DBLPaN and branches, measur...
Diagnostic utility of trigeminocervical reflex and quantitative sensory testing in horses with trigeminal-mediated headshaking. Assessment of trigeminal nerve (TN) function in horses with trigeminal-mediated headshaking (TMHS) using trigeminocervical reflex (TCR) and quantitative sensory testing (QST) has not been investigated. Objective: Horses with TMHS show lower TCR and QST thresholds than controls. A subset shows left-to-right differences. Methods: Privately owned horses with TMHS (n = 12) and secondary headshaking (sHS; n = 4), from a referral hospital. Headshaking-free controls (n = 14), from the hospital's teaching herd or privately owned. Methods: Prospective case-control-study. In unsedated horses, TCR ...
Evaluating ex vivo toll-like receptor agonist response as a potential biomarker in equine gastric ulcer syndrome. Equine gastric ulcer syndrome (EGUS) is highly prevalent in horses. Despite its presumed painful nature, evaluation of objective biomarkers associated with EGUS presence and severity remains limited. The objective of this study was to investigate the potential of interleukin-1 beta (IL-1β) release by peripheral blood mononuclear cells (PBMCs) following ex vivo stimulation of toll-like receptors 2 and 4 (TLR2 and TLR4) as a potential biomarker for EGUS status, with gastric lesions used as a proxy for presumed EGUS-associated pain. Venous blood was collected from 77 horses, PBMCs were isolated ...
Analgesic use, safety and pharmacokinetics of acetaminophen in equids: A structured scoping review. Despite its frequent use in equine clinical practice, scientific data on the use of acetaminophen in horses remain limited. Objective: To map and critically appraise the available evidence on the analgesic use, safety and pharmacokinetics of acetaminophen in horses. Methods: Structured scoping review. Methods: A comprehensive search was performed in accordance with the PRISMA Extension for Scoping Reviews using the terms '(paracetamol OR acetaminophen) AND (pain OR safety OR toxicosis OR pharmacokinetics) AND (horse OR pony OR donkey OR mule)' across Web of Science, Scopus, and PubMed from dat...
Multi-Detector Helical Computer Tomography, Transrectal Ultrasonography and Histology of the Lumbosacral Area: A Comparative Study in Warmblood Horse Cadavers. Pain arising from the lumbosacral region is a recognized cause of poor performance and impaired welfare in horses. However, structural changes in the intertransverse joints (ITJs), lumbar articular process joints (APJs), and lumbosacral intervertebral discs (LSDs) may also occur in asymptomatic horses, complicating interpretation of imaging findings.This study evaluated these structures in 14 middle-aged Warmblood cadavers that were not lame according to the owners prior the onset of the problem that resulted in euthanasia or slaughter and correlated ultrasonographic (US) and computed tomograp...
Factors affecting veterinary perception of the prevalence of back pain and dysfunction in dogs and horses. The prevalence of back pain in humans has been extensively reported, but in dogs it is unknown. In horses, research on the prevalence of back pain exists, but with reports ranging from 1% to 94%, indicating a data deficiency. Unassigned: Veterinarians were surveyed about their perception of the prevalence of back pain and dysfunction in dogs and horses for 6 different clinical scenarios. The respondents' education background and physical examination techniques were recorded. Unassigned: Perceptions of the prevalence of back pain and dysfunction varied widely both within and between education g...
Epidural 0.125% ropivacaine is safe but insufficient for induced tibiotarsal joint pain. Epidural injection of a low concentration of the local anaesthetic ropivacaine produces analgesia without neurological deficits or ileus in people. Objective: To determine if epidural 0.125% ropivacaine mitigates induced hindlimb lameness in horses while preserving neurological function and gastrointestinal (GI) motility. Methods: Randomised, blinded, controlled, crossover study. Methods: Eight healthy, sound horses underwent two treatments in random order, separated by at least 3 weeks: epidural saline or epidural ropivacaine. For each treatment, an epidural catheter was inserted at the fir...
Thermographic analysis of chiropractic care on the back health of Mangalarga Marchador horses. Poor saddle fit can cause back pain and lesions in horses, highlighting the need for preventive therapies. Objective: To evaluate the effects of chiropractic treatment on the backs of Mangalarga Marchador horses using infrared thermography to monitor thermal changes associated with saddle-induced overload. Methods: Physiological, environmental, thermographic, and chiropractic parameters were evaluated in 13 horses subjected to a standardized 25-min exercise session. Animals were assigned to either a control group (GC, n = 6) or a chiropractic treatment group (GT, n = 7). Assessments were c...
Quantifying the Equine Pain Response to Paracetamol Administration in Horses With Chronic Lameness Already Receiving Non-Steroidal Anti-Inflammatories. Paracetamol is used in horses alongside non-steroidal anti-inflammatories (NSAIDs) for multi-modal analgesia; however to date there are few studies published which have investigated its analgesic effect in the horse. Horses were recruited to this study from a population of geriatric horses at The Horse Trust. Horses were selected based on the following inclusion criteria; documented naturally occurring chronic lameness and being treated with an NSAID at the licensed dose and dosing interval. This population was assessed with a five-point subjective lameness grading system performed live by two...
Eight Weeks of 448 kHz Radiofrequency Therapy Increases Multifidus Muscle Cross-Sectional Area and Modulates Thoracolumbar Range of Motion in Horses with Chronic Back Pain. We aimed to investigate the effects of an 8-week 448 kHz radiofrequency (RF) on multifidus cross-sectional area (CSA) and thoracolumbar differential range of motion (ROM). Eight Thoroughbred horseball horses received four RF treatments (T9-L6) at 2-week intervals. Multifidus CSA (T10-L5) and differential spinal ROM between the withers (W), T13, T18, L3 and sacrum (S) were measured before treatment, immediately after the first session, 24 h after the first session, and at 8 weeks (15 days after the last session). Linear mixed models with Tukey post hoc comparisons were used. Significant effects...
Short-term effects of pulsed electromagnetic field therapy on subjective flexion-associated lameness responses and circulating cytokines in horses with distal tarsal osteoarthritis. Pulsed electromagnetic field (PEMF) therapy is commonly used in equine sports medicine for its proposed anti-inflammatory effects; however, limited controlled studies have evaluated its physiologic effects in horses. Objective: The objective of this study was to investigate the effects of PEMF therapy on flexion-induced lameness and circulating cytokines in horses with radiographic evidence of distal tarsal osteoarthritis. Methods: Six mares were enrolled in a repeated-measures crossover design in which each horse served as its own control. Horses were evaluated at baseline (sham PEMF) and at ...
Perineural dexamethasone does not prolong bupivacaine sensory blockade in equine palmar digital nerve blocks: a randomized crossover trial. To determine whether dexamethasone sodium phosphate (dexamethasone SP) prolongs the sensory blockade produced by perineural bupivacaine during medial and lateral palmar digital nerve blocks in horses. Unassigned: 8 healthy adult horses were enrolled in a blinded, randomized 4 X 4 crossover trial. Each horse received 1 of 4 perineural treatments over the palmar digital nerves of the left forelimb: bupivacaine, bupivacaine + dexamethasone SP, dexamethasone SP alone, or saline. A minimum 7-day washout was used between treatments. Mechanical nociceptive threshold (MNT) was measured at baseline and...
An Investigation of the Role of Ridden Exercise, Including Application of the Ridden Horse Pain Ethogram, in Pre-Purchase Examinations of Sports Horses. Many horses undergo a pre-purchase examination (PPE) prior to acquisition by a new owner; however, despite evidence that lameness and canter dysfunction may only be apparent during ridden exercise, ridden exercises assessing gait quality is not a routine part of PPEs. The objectives were to determine the influence of the results of ridden exercise on decision-making concerning risk assessment for purchase and to establish the long-term performance of horses. Twenty-five sports horses underwent PPEs including ridden exercises to assess gait quality and to apply the Ridden Horse Pain Ethogram (R...
Administration Study of Bedinvetmab, an Antinerve Growth Factor Monoclonal Antibody, in Horses for Doping Control Purposes. Monoclonal antibodies (mAbs) targeting nerve growth factor (NGF) represent a novel therapeutic approach for managing acute and chronic pain in humans and animals. However, their potential misuse as pain-masking agents in competitive equine sports raises significant welfare and integrity concerns. To enhance understanding of the elimination profile of anti-NGF mAb if misused in horses, this study describes the first administration of bedinvetmab (a canine anti-NGF mAb) in three geldings, establishing its plasma elimination profile following subcutaneous administration. Bedinvetmab plasma concen...
Repeatability and test-retest reliability of thermal and pressure pain threshold testing in healthy thoroughbred horses. Quantitative sensory testing (QST) has been used in horses to assess nociceptive responsiveness but its broader clinical application is limited by variability across anatomical sites, environmental conditions, operator technique, and behavioral endpoints. This study aimed to evaluate the feasibility, within-session repeatability, and test-retest reliability of thermal threshold (TT) and pressure pain threshold (PPT) testing in healthy Thoroughbred horses. Unassigned: Eleven adult Thoroughbred horses (4 mares, 7 geldings; median [IQR] age 6 [5-6] years; body weight 558 ± 47 kg) underwent...
Diagnostic criteria for equine thoracolumbar myofascial pain syndrome: A foundational study. Diagnostic criteria for myofascial pain syndrome (MPS) are well established in humans but remain underexplored in horses. This study aimed to identify which MPS clinical signs were present in the equine thoracolumbar region, assess internal coherence among clinical indicators, and explore the diagnostic relevance of owner-reported behavioural, signalment, management, and clinical variables. A population of 120 horses underwent a static physical assessment of the thoracolumbar region. Owner-reported horse behaviours were collected through a questionnaire. Taut band, hypersensitive spot, local t...
Assessment of pharmacokinetic parameters, oral bioavailability, and physiological effects of amantadine in horses. Without adequate pain management, central nervous system plasticity can result in acute or adaptive pain developing into chronic or maladaptive pain. This is difficult to manage and often unresponsive to traditional analgesics. An important mechanism associated with maladaptive pain is central sensitization which results in part from increased NMDA (N-methyl-D-aspartate) receptor activation. Amantadine is an NMDA receptor antagonist that has been used in combination with opioids and NSAIDs in humans and dogs for the treatment of conditions associated with central sensitization. The goal of the...
Characterization of the Pharmacokinetics and Physiological Effects of Tapentadol in Horses. Tapentadol is a dual mechanism analgesic utilizing both μ-opioid receptor (MOR) agonism and norepinephrine reuptake inhibition (NRI). This study evaluated the pharmacokinetics and pharmacodynamics of tapentadol as a potential analgesic with the goal of treating pain in horses. Pharmacokinetics of both tapentadol and tapentadol-O-glucuronide were elucidated. Six horses received three separate escalating single oral doses (1, 3, and 5 mg/kg) and a single intravenous (0.32 mg/kg) dose of tapentadol in a four-period sequential design. Concentrations of tapentadol and tapentadol-O-glucuronide ...
Musculoskeletal Burden in German Equestrians: Hip-Specific Symptoms and Risk Factors. Equestrian sport is a major component of German athletics, with broad recreational participation and a strong competitive sector. In 2019, about 2.32 million people identified as active riders, and more than 60,000 competitional licences were issued in 2021, reflecting substantial competitive engagement across the Olympic disciplines and national performance levels. Hip pain is a frequent and clinically relevant complaint among athletes and can stem from structural, degenerative, or overuse-related causes. In riding, the hip joint is crucial for transmitting forces and coordinating rider-horse...
A study of the forces generated during equine cheek tooth extraction. Significant force is often applied when elevating equine teeth from the alveolus during extraction. No previous studies have investigated these forces. Objective: To develop a method to allow measurement of elevation forces (EF) applied during extraction, and to record forces during extraction of cheek teeth in both cadaver specimens and clinical cases, evaluating factors that might affect this and comparing differences between tooth positions and horse signalments. Methods: In vitro experimental study of cadavers and observational study of a convenience sample of clinical cases. Methods: Stra...
A multimodal approach to equine thoracolumbar myofascial pain: integrating clinical examination, AI-based gait analysis, and the ridden horse pain ethogram. Myofascial pain syndrome (MPS) is considered highly prevalent in horses, yet it is frequently underdiagnosed due to limited understanding of its clinical presentation and functional consequences, as well as the inherent challenges associated with its clinical assessment and objective measurement. In equines, the relationship between palpation-based MPS indicators, gait asymmetries, and pain-related behaviours during ridden work remains unclear. The primary aim of this study was to evaluate the association between thoracolumbar palpation pain scores and gait asymmetries measured in-hand and dur...
Mitigating and addressing complications in equine laparoscopy. The purpose of this article was to report a condensed overview of current strategies for mitigating and managing complications in equine laparoscopic surgery. Minimally invasive surgical techniques have become standard in equine surgery for a variety of diagnostic and therapeutic procedures, with purported advantages including reduced postoperative pain, expedited recovery, fewer incisional complications, and enhanced visual imagery for the surgeon compared to traditional open approaches. Despite these benefits, complications can arise, and the literature demonstrates variability in definition...
Ovum pick-up in mares: Evidence review and best practice recommendations using a modified GRADE approach. Ovum pick-up (OPU) is a procedure that is now performed in mares worldwide to harvest oocytes for in vitro embryo production. There is a lack of consensus surrounding best practices for various procedural elements of the technique and recently there has been an increasing focus on the welfare aspects of the procedure. Our objective was to summarize current practice and to develop guidelines for OPU in the mare, using a modified GRADE approach to optimize efficiency and mare welfare. Published evidence on various aspects of the procedure was compiled, and to supplement the relative lack of publ...
Case Report: Oral and topical chronic administration of THC-rich and CBD-rich cannabis oil as palliative care in a rescued horse with open wound, sarcoid and chronic pain. Cannabinoid-based therapies have shown analgesic, anti-inflammatory, and wound-healing potential across veterinary species; however, clinical data on long-term use of THC-rich formulations in horses remain scarce. This case report describes the use of combined oral and topical THC-rich and CBD-rich full-spectrum cannabis oils as part of a palliative care strategy in a rescued horse with severe chronic disease. A senior mixed-breed gelding was rescued with a large, chronic ulcerative lesion of the left hind limb, severe malnutrition, non-weight-bearing lameness (AAEP grade 5/5), and refractory ...
Evaluation of doppler indexes of the lateral palmar digital artery in lame sport horses. Although lateral palmar digital artery (LPDA) flow velocity does not differ between forelimbs, horses with lameness typically reduce loading of the affected limb during the weight-bearing phase. This study aimed to assess whether Pulsed-Wave (PW) Doppler indices of the (LPDA) blood flow differ between the two forelimbs in horses with unilateral forelimb lameness, and whether these differences correlate with lameness severity. Twenty-seven lame and 15 healthy horses were enrolled. All Doppler ultrasonographic examinations were performed by a single operator, blinded to both the presence or abse...
Use of Intraperitoneal Lidocaine in Horses Undergoing Laparotomy for Colic. Perioperative lidocaine is widely used in horses with acute abdomen for its analgesic, prokinetic, anti-inflammatory, and anti-endotoxic effects, although evidence of its visceral analgesic efficacy remains inconclusive. Given the potential of alternative routes of administration for local anaesthetics, this prospective, randomised, unblinded clinical trial evaluated whether intraperitoneal (IP) lidocaine improves early postoperative recovery, including recovery from anaesthesia and the first 24 h after laparotomy for colic. A Multifactorial Numerical Rating Composite Pain Scale for equines wa...
Combined PRP and CCP Therapy Suppresses Inflammation and Protects Cartilage in Post-Traumatic Osteoarthritis. This study aimed to evaluate the therapeutic effects of platelet-rich plasma (PRP) and Cervus and Cucumis polypeptide (CCP) injections in rats with post-traumatic osteoarthritis (OA). The model was established by transection of the anterior cruciate ligament, and the animals were subsequently treated with PRP and CCP. Articular cartilage degeneration was assessed through gross morphological observation, histopathological staining, and a standardized scoring system. Concurrently, pain-related behaviors, joint swelling, levels of inflammatory cytokines, and markers associated with extracellular ...
Owner satisfaction and animal welfare after bilateral enucleation in horses. Bilateral enucleation in horses represents a challenging decision for owners, undertaken to relieve chronic, untreatable ocular pain. Emotional distress and uncertainty regarding postoperative welfare often lead to euthanasia instead of surgery. Objective: To evaluate owner perceptions of equine quality of life before and after bilateral enucleation, and to assess satisfaction with the procedure. Methods: Retrospective case series. Methods: Medical records from 21 horses that underwent bilateral enucleation between 2016 and 2024 were reviewed. Owners completed a structured survey assessing sat...
Myofascial trigger points as a primary cause of equine lameness: a biomechanical, neurophysiological, and fascial review. Equine lameness diagnosis is dominated by a joint- and tendon-centric paradigm. The standard diagnostic algorithm relies on gait observation, perineural and intrasynovial anesthesia, and cross-sectional imaging. It is directed almost exclusively at skeletal and articular structures. Myofascial trigger points (MTrPs) are hypersensitive, hyperirritable loci within taut bands of skeletal muscle. They produce local and referred pain on compression or contraction. In horses, MTrPs are a clinically relevant but systematically overlooked source of primary lameness. This review synthesises evidence fr...
