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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.
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...
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...
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...
Welfare Assessment in Equine-Assisted Service (EAS) Horses. Equine-Assisted Service (EAS) horses can be exposed to stressors that affect their behavior and welfare. Previous studies investigated behavioral and physiological indicators (PI) only during therapy sessions. This study evaluated the frequency of stress and pain behaviors (FSPB) in horses with different riders, while assessing welfare through housing, management, and PI. Ten horses were observed during EAS sessions with three rider groups: able-bodied, clients with significant physical impairment, and clients with no significant physical impairment, totaling twenty-six riders. Behavioral data...
The immediate effect of whole-body vibration therapy on mechanical nociceptive thresholds in horses with thoracolumbar pain. Treating primary back pain in horses can be challenging and often necessitates a multimodal approach. Whole-body vibration therapy (WBV) has been used in both horses and humans to alleviate pain and strengthen muscles. A recent study showed worsening back pain following a 30-minute session of WBV; however, the immediate effects of WBV were not evaluated. The purpose of this study was to assess the immediate effects of whole-body vibration therapy on horses with back pain after a single session of WBV. Objective: The objective of the current study was to determine the immediate effects on mecha...
Heart rate variability in horses with naturally occurring gastric ulcers: Response to omeprazole and sucralfate treatment. Equine gastric ulcer syndrome (EGUS) is the most common disease affecting the equine stomach. Heart rate variability (HRV) describes and quantifies the variability between consecutive heartbeats due to the neurohormonal regulation of the heart. It has been considered a non-invasive method to detect autonomic tone changes that can be influenced by pain and disease. Unassigned: This study aimed to assess the HRV indices in horses affected by EGUS submitted or not to treatment. Unassigned: A cohort of 45 mares underwent baseline gastroscopy (T0); 24/45 mares diagnosed with Equine Squamous Gastric...
Assessment of acute and chronic pain in working horses and donkeys in Egypt and the influence of observer training. Pain assessment can support monitoring welfare in working equids. Objective: To assess agreement of structured pain scores before and after training observers and to assess differences in pain scores between working equids with or without acute or chronic pain and to compare them to non-working equids. Methods: In part 1, eleven veterinarians and nine technicians performed pain scores before and after training. Agreement with reference scores was analyzed with Intra Class Correlation (ICC) analysis. In part 2, pain assessments were performed in 96 donkeys (n=40 fit-to-work, n=21 acute pain, n=...
Deep digital flexor tenotomy provides pain relief and clinical comfort in horses with chronic laminitis. This study evaluated the clinical application, outcomes, and prognostic indicators of deep digital flexor tenotomy (DDFT) in horses with chronic laminitis. Unassigned: A computer-generated search identified all possible cases of laminitis for horses referred to the George D. Widener Hospital for Large Animals at the University of Pennsylvania between 2010 and 2022. Medical records were reviewed for a diagnosis of laminitis by clinical examination and radiographs. The population was characterized by breed, age, clinical features, and radiographic findings. Poisson regression was performed to id...
Overview of the Current Osteoarthritis Treatment in Veterinary Medicine and Future Directions. Osteoarthritis (OA) is a chronic and progressive joint disease that can cause permanent loss of joint function. OA is highly prevalent in horses, dogs, and cats, affecting different joints and leading to reduced mobility and chronic pain. Different risk factors for animal OA have been identified, including trauma and breed. Inflammation is a hallmark of the disease, with various underlying mechanisms such as cyclooxygenase and metalloproteinase activation, nerve growth factor, cytokine, and prostaglandin upregulation, among others. Although disease complexity makes OA difficult to treat, eno...
Evaluation and Management of the Horse with Head and Neck Disorders. Recognizing possible causes of equine head and neck problems requires a careful and systematic evaluation. While for some disorders reaching a diagnosis and treatment plan is relatively straightforward, for others this can be a complicated road requiring extensive diagnostic techniques, treatment trials, and management strategies. The ability to determine whether the patient is in a painful state, experiencing functional deficits, or in a combination of pain and dysfunction is critical to developing an effective treatment plan. Frequently, behavioral concerns often associated with pain must be...
Effects of various perineural analgesia techniques on decreasing experimentally-induced lameness of the equine metacarpophalangeal joint. Recent evidence has shown that perineural analgesia may be less specific than previously thought. Objective: To compare the effects of four distal limb perineural analgesia techniques on resolving synovitis-induced lameness of the equine metacarpophalangeal joint (MCPJ). Methods: Nine horses had one MCPJ injected with 75ng of recombinant equine interleukin-1β (reIL-1β). Ten hours later, horses underwent one of two blocking patterns: (1) a palmar digital (PDNB) followed by an abaxial sesamoidean (ASNB) nerve block or (2) a palmar metacarpal (PMNB) followed by a palmar (PaNB) nerve block. Skin...
Preliminary Investigation of a Transcutaneous Ultrasound-Guided Technique for Pudendal Nerve Block in Six Horse Cadavers. Regional anaesthesia of the equine anogenital tract is limited to local infiltration, extradural, blind palpation and nerve stimulator-guided techniques which risk iatrogenic damage, recumbency and ataxia. This study aimed to describe and assess the feasibility of transcutaneous ultrasound-guided (USG) pudendal nerve staining in equine cadavers. An initial pilot phase used two fresh equine cadavers and one standing unsedated horse to image the intrapelvic anatomy using ultrasound. One fixed equine cadaver specimen was also dissected to identify the pudendal nerve and refine the dissection appr...
Client-specific outcome measure for chronic osteoarthritis pain assessment in horses. Osteoarthritis (OA) is a prevalent cause of chronic pain and lameness in horses. Whereas lameness can be quantified using objective measures, the assessment of OA-associated pain remains challenging. This study aimed to evaluate the applicability of the Client-Specific Outcome Measure (CSOM), a tool widely used in small animals, for the assessment of chronic OA pain in horses through caretaker evaluation. Unassigned: Seventeen privately owned horses with confirmed OA were enrolled in a 20-week randomized, double-blind, placebo-controlled study. For each horse, three individual pain-related ind...
Main causes of death in aged horses in a retirement facility in California can be attributed to the digestive and musculoskeletal systems. To determine the main causes of death in aged horses residing at a retirement facility in California. Unassigned: A retrospective cross-sectional study design was utilized to evaluate signalment, medical history, and necropsy reports of horses aged 20 years or older at death and housed at a single retirement facility. All cases underwent a standard post mortem evaluation from 2010 through 2020 by the University of California-Davis William R. Pritchard Veterinary Medical Teaching Hospital. Euthanasia decisions were made by the retirement facility staff in consultation with a veterinarian. The m...
Decoding moody mare syndrome: Retrospective study and tiered diagnostic framework. Behavioral issues, such as persistent or strong estrus, non-specific pain, and performance challenges in mares are frequently attributed to the estrous cycle. Objective: The objectives of this study were to analyze retrospective data on mares presented for estrus-related behavioral complaints, and to propose a structured diagnostic framework for categorizing cases during work-up at different levels of care. Methods: A retrospective study was conducted using patient records of a total of 14993 mares. Results: In this data set, behavioral problems, pain, or poor performance were not repeatably v...
Assessment of Blood Profiles and Pain in Sport Horses Undergoing Intrarectal Ozone Therapy. Medical ozone is used in various treatments due to its oxidising properties. Objective: We aimed in this study to evaluate the impact of intrarectal ozone therapy on haematological and biochemical parameters, as well as the pain induced by the procedure in sport horses. Methods: In vivo experiment with 12 Quarter Horses (3 males and 9 females) used as their own controls to assess the effects of ozone therapy. Methods: Blood samples were collected before treatment (Control), 24 h after ozone therapy (24 h post-treatment), and 7 days after the last day of ozone therapy (7 days post-treatment). ...
The effect of botulinum toxin injection into the deep digital flexor muscle on foot biomechanics in healthy horses. To examine the effects of botulinum toxin inoculation into the deep digital flexor (DDF) muscle on foot biomechanics. Unassigned: 6 healthy horses were injected with botulinum toxin in the DDF of 1 forelimb. The opposite forelimb was untreated. Ground reaction forces (GRF) were measured using a pressure sensor in regions of interest, including the dorsal hoof wall (toe). The location of the center of pressure (COP) was measured relative to the dorsal hoof wall during static standing and at peak stance during walking. Repeat measurements 3, 7, 14, 28, and 42 days after injection were compared t...
Investigating the effect of surface cryotherapy on equine patient compliance to infraorbital nerve block placement. To investigate the effect of applying ice to the skin overlying the infraorbital canal on the compliance of healthy adult horses to infraorbital nerve block placement during standing sedation. Methods: Blinded, randomized crossover trial. Methods: Thirty healthy adult horses [16 ± 3.9 years old (mean ± standard deviation), weighing 594 ± 63 kilograms (kg)]. Methods: Each horse acted as its own control with a minimum of 7 days between treatments. Horses were sedated using detomidine hydrochloride, and sedation level was evaluated using a published simple descriptive scale. Horses were random...
