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.
Arnbjerg J.After a short review of previous literature about fractures of the navicular bone in horses, the symptoms and the pathological-anatomical changes of the condition are described. The most important clinical symptom is acute severe lameness without significant swellings, but with pronounced pain reaction to rotation of the coffin joint. After rest the lameness is reduced considerably, but without treatment it can persist for several years. Adherences between the deep flexor tendon and the site of the fracture and eventual damage to the coffin joint are considered to be the cause of the persistin...
Pippi NL, Lumb WV.An equine model, subjected to three kinds of pain (superficial, deep, and visceral) was used to test effects of analgesic drugs. Two groups of ponies were used. In the first group of six ponies, six drugs (fentanyl, meperidine, methadone, oxymorphone, pentazocine, and xylazine) were given according to a Latin square experimental design, and tests were made at 30-minute intervals for 4 hours. Mean values (control) for the three kinds of pain were obtained before and after the tests and were compared with the mean values (drugs) obtained over 2- and 4-hour intervals (four and eight measurements ...
Blue MG.Four cases of enterolith obstruction in horses aged from six to 14 years are reported. All four cases had symptoms of persistent low grade abdominal pain and anorexia with an absence of defaecation. Examination revealed reduced gut motility and accumulation of gas, but heart and respiratory rates, rectal temperatures and complete blood counts were all within normal limits. Enteroliths of varying sizes were removed from the region of the transverse colon in all four horses.
Valdez H, Adams OR.After preliminary studies on cadavers, a surgical approach was developed for removal of the medial meniscus, offering maximal exposure and minimal trauma to the articular surfaces of the medial tibial plateau and femoral condyle. Medial meniscectomy was then performed on 10 clinically normal horses that had been given general anesthesia. Nine horses were euthanatized at intervals of 1 to 6 months, and the joints were evaluated grossly and histologically. (One horse will be examined 1 year after surgery). Medial meniscus tears were diagnosed in 5 horses; medial meniscectomy was done on 4 horses...
Pearson H, Weaver BM.The paper reports 6 cases of priapism with subsequent protrusion and paresis after neuroleptanalgesia and anaesthesia in horses. Five were ultimately treated by amputation of the penis but the sixth horse is responding satisfactorily to conservative treatment at the time of writing. Causative factors, preventive measures and possible methods of treatment are discussed.
Short CE, Brunson DB.Anesthetic management of the pleasure horse consists of the appropriate selection and administration of pre-anesthetic medications including anticholinergics, tranquilizers and narcotics followed by appropriate techniques of anesthetic induction. The anesthetic induction must vary somewhat for the pleasure horse practice since many of the procedures are completed on farms and ranches. As a result the inducing of anesthesia will frequently be with the same agent which will be used to maintain anesthesia. Noticeably will be the reduction and duration of anesthesia and surgical time. The inductio...
Auer JA, Garner HE, Amend JF, Hutcheson DP, Salem CA.The duration and quality of recovery after separate 2 hour anaesthetic periods with equipotent alveolar concentrations of isoflurane, enflurane, halothane and methoxyflurane were evaluated in experimental ponies. Recovery was shortest after isoflurane anaesthesia, followed by enflurane, halothane and finally methoxyflurane, although standing was achieved more rapidly after enflurane than after isoflurane. This sequence of recovery times was compatible with the respective solubilities of the 4 agents. The smoothest recovery was obtained after isoflurane anaesthesia, followed by methoxyflurane, ...
Pickett BW, Voss JL.Experimental and clinical observations were made to treat abnormal sexual behaviour. The most common cause of abnormality was mismanagement of the animal; over-use and rough treatment at service and too-frequent ejaculation during winter had a detrimental effect on the behaviour of young stallions. Pain due to injury incurred at copulation or when associated with mounting attempts was also a common cause of impotence. Most impotent stallions responded well to re-training and recovery can be achieved without pharmacological treatment in most cases.
Jeffcott LB, Hickman J.This paper describes the surgical treatment of 14 horses exhibiting chronic back pain attributed to impaction and overriding of the dorsal spines in the thoracolumbar region. The technique involved the resection of the summits of one or more dorsal spines following midline division of the supraspinous ligament. All the horses returned to full work after a convalescent period of at least four months, and 12 of them showed considerable improvement in their form and performance. A post-surgical complication encountered in one case was the development of new bone on the edge of a resected spine. T...
Hördegen KM.115 horseback riders have undergone clinical and radiologic examinations of the spine. A minimum of 10 years' riding was required. Depending on intensity of training and number of riding hours, the subjects were divided into three groups: roughriders, sport riders and hobby riders. It was striking that of the bare half of cases (51) suffering from lower back, only 8 (about 15%) had had medical treatment and actually been disabled. Moreover, 47% of the riders with lower back pain were painfree in the saddle, i.e. when riding. No causal connection was found between riding and a higher incidence ...
Jeffcott LB.A description of some of the clinical features of low back pain in the horse has been given and a number of methods for assisting diagnosis considered. As well as a complete clinical examination both at rest and during exercise, a useful diagnostic aid in some chronic cases was the injection of local anaesthetic into the interspinous spaces. A laboratory examination, including haematological and biochemical profiles, was undertaken in all cases. The serum enzymes GOT and CPK were particularly valuable as an aid to diagnosis in atypical tying-up. A technique for radiography of the vertebral col...
Coffman JR.Initial examination and therapy, and the avoidance of maltreatment are emphasized. Gastric decompression is of prime importance, after which no compound should be administered via stomach tube. Where large amounts of high starch grains are fed, primary acute gastric dilatation must be differentiated from that secondary to small bowel dilatation, by immediate gastric intubation and irrigation of the cardia with lidocaine. If cessation of pain and improvement of peristalsis and general attitude follow, the former state may be assumed. If pain persists and peristalsis does not improve markedly, o...
Donawick WJ.The horse with an abdominal crisis caused by acute gastro-intestinal tract obstruction develops hypovolaemia, haemoconcentration, electrolyte depletion, metabolic acidosis and shock. During preparation for operation, treatment with fluids, antibiotics and bicarbonate will impede metabolic imbalance. Stomach decompression may slow the passage of sodium, water and potassium to the gut lumen, reduce pain and minimize the risk of stomach rupture. Selected laboratory determinations and the monitoring of arterial and venous pressures will provide a measure of security, and serve as a guide to replac...
Paranjape VV, Knych HK, Berghaus LJ, Giancola S, Cathcart J, Reed RA.Anatomical location-dependent differences in transdermal opioid penetration are well described in human patients. Although this has been investigated in horses with fentanyl, there is no literature available on location-dependent plasma buprenorphine concentrations when administered as a transdermal matrix-type patch. Unassigned: This study aims to compare the plasma concentrations achieved from the matrix-type transdermal buprenorphine patches placed at different anatomical sites (metacarpus, gaskin, and ventral tail base) in healthy adult horses. Unassigned: This is a randomized experimental...
Pratt S, Sole-Guitart A, de Klerk K, Evans E, Hume J, Palmieri C, Rainger J, Goodwin W.Post-traumatic distal limb wounds cause discomfort and heal gradually by second intention. The topical application of Tri-Solfen (lidocaine hydrochloride, bupivacaine hydrochloride, adrenaline acid tartrate and cetrimide [LBAC]) produces effective postsurgical cutaneous analgesia in lambs, calves and piglets; however, its effect on wounds in horses is unknown. The antinociceptive effect, measured by mechanical threshold (MT), and the wound healing impacts of LBAC compared with saline were investigated on surgically created 20 × 20 mm distal limb wounds in 10 horses. Treatment was applied once...
Pickles KJ, Marlin DJ, Williams JM, Roberts VLH.Equine trigeminal-mediated (TGM) headshaking (HS) is a neuropathic facial pain syndrome characterised by varying intensity and frequencies of head movements and signs of nasal irritation. An accurate method for quantification and/or characterisation of HS severity is lacking. Objective: To develop and validate an objective measure of TGMHS. Methods: Prospective case control study. Methods: Horses presenting for investigation of HS were recruited alongside those presenting for forelimb lameness (LAME) and pre-purchase examination as well as healthy controls (CONTROL). Head movement data were co...
Beldeanu S, Tay MCA, Daniel C, Dosi MCM, Hahn CN, James O, Townsend NB, Liuti T, Schwarz T, Parkinson NJ.Fractures of the paracondylar process of the occipital bone may cause headshaking, neck pain and neurologic deficits. The condition is being recognised more frequently with increasing availability of computed tomography. However, to date only limited information is available as to presentation, treatment, surgical approach and outcome. Objective: To describe the clinical signs, imaging findings, treatment, surgical approach and outcome in three horses diagnosed with paracondylar process fracture. Methods: Retrospective case series. Methods: Clinical records and diagnostic images of affected ca...
Azizi S, Mazaheri-Khameneh R, Davoodi F, Gooran MM, Ghoreishi SS, Mozaffari N, Dalir-Naghadeh B.In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10-month-old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention. A 10-month-old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the ...
Wickstead FA, Milner PI, Bardell DA.Wound infusion catheters (WICs) have been used in humans and some veterinary species for post-operative local anesthetic administration following a variety of surgical procedures, aiming to reduce post-operative analgesia requirements and improve patient comfort. Benefit in reduction in pain, post-operative analgesia requirements and length of hospital stay are well documented in humans, but use of WICs may not have been widely adopted in veterinary species due to the concern of increased complications, such as dehiscence or surgical site infection (SSI), creating a barrier to their use. This ...
Osborne C, Elce YA, Byrant B, Meehan-Howard L.To determine with mechanical nociceptive threshold (MNT) testing whether distal limb skin sensation is affected by intra-articular anesthesia of the tarsometatarsal joint (TMTJ). Unassigned: This was a prospective cohort study. Ten client-owned horses that had intra-articular TMTJ anesthesia were included in the study. The MNT was measured at 6 sites on the distal limb at 3 time points: before anesthesia (T0) and at 10 min (T10) and 30 min (T30) post-injection. Linear mixed-model analyses were done, with the significance level set at P < 0.05. Unassigned: There was an increase in MNT (P = 0.00...
Wolschrijn CF, Smit IH, Schouten J, Moller Te NCR.Facial expressions are important in pain recognition in horses, but current observation-based pain scales remain subjective. A promising technique to quantitatively measure subtle changes in expression patterns, including changes invisible to the human eye, is surface electromyography (sEMG). To achieve high-quality and reliable sEMG signals, unilateral placement of bipolar electrodes is required in relation to the motor endplates (MEP). We aimed to localize the nerve entry points (NEPs; where the nerve branch first pierced the muscle belly) and the direction of the terminal nerve endings to e...
Nowak M, Martin-Cirera A, Jenner F, Auer U.Pain assessment in horses presents a significant challenge due to their nonverbal nature and their tendency to conceal signs of discomfort in the presence of potential threats, including humans. Therefore, this study aimed to identify pain-associated behaviors amenable to automated AI-based detection in video recordings. Additionally, it sought to determine correlations between pain intensity and behavioral and postural parameters by analyzing factors such as time budgets, weight shifting, and unstable resting. The ultimate goal is to facilitate the development of AI-based quantitative tools f...
De Schryver M, Oosterlinck M.Perineural anesthesia of the tibial nerve can be performed ultrasound-guided or blindly, with the latter still being commonly used in equine practice due to practical constraints, despite its lower accuracy and hence, common failure to achieve desensitization. This may be associated with anatomical variations or inadequate landmarks for injection. To examine the course of the tibial nerve, document potential anatomical variations, and determine optimal landmarks for perineural injection, dissection was conducted along the medial aspect of the tibia in 10 paired cadaver hindlimbs. No anatomical...
McCarrel TM, Cole C, Maxwell LK, Roe HA, Morton AJ.To determine (1) the dose of liposomal bupivacaine (LB) to eliminate grade 2 of 5 lameness, the (2) duration of analgesia of LB versus bupivacaine hydrochloride (BH), and (3) LB pharmacokinetics versus BH. Methods: A reversible lameness model was validated in conditioned Thoroughbred horses (n = 12), aged 3 to 10 years. A dose-response trial compared subjective and objective lameness following abaxial sesamoid block with 25 mg BH/nerve or 30, 60, or 133 mg LB/nerve (n = 3/group). The LB dose that eliminated lameness and reduced lameness for the longest was used for blinded, randomized, crossov...
Franzen V, Gruber NA, Klußmann S, Schoster A, May A.Trigeminal-mediated headshaking is a neuropathic facial pain condition in horses. No treatment has been entirely successful. Repetitive transcranial magnetic stimulation (rTMS) is used in human medicine as a treatment for various neuropathic pain conditions, and good results have been achieved in cases of trigeminal neuralgia. Objective: Apply rTMS to horses with trigeminal-mediated headshaking (TMHS) and to evaluate tolerability, application of the setting, and success rate. Methods: Seventeen horses with nonseasonal signs of TMHS. Methods: Other underlying causes of headshaking were ruled ou...
Knych HK, Steinmetz SJ, Traynham ML, McKemie DS, Kass PH.Morphine is an effective analgesic in horses, however, IV administration at therapeutic doses has been shown to produce dose-dependent neuroexcitation and unwanted gastrointestinal effects. The analgesic effects of morphine have, at least in part, been attributed to the morphine-6-glucuronide (M6G) metabolite. Oral administration to horses results in comparable M6G concentrations to that achieved following IV administration of a therapeutic dose without the adverse effects. The anti-nociceptive effects have not yet been reported. In the current study the thermal anti-nociceptive effects of sin...
Cole RC, DeGraves FJ, Schumacher J, Brown J.To determine the effect of 1.5 mL 2% mepivacaine, 0.75 mL 2% mepivacaine, and a combination of 0.75 mL 2% mepivacaine with epinephrine (1:200,000 solution) administered over each palmar digital nerve (PDN) to 6 horses with naturally occurring lameness caused by digital pain. Methods: In a crossover study design, 6 horses with forefoot-related lameness were randomly assigned to 1 of 3 groups. Each group received, on different study days, a PDN block using 1.5 mL of 2% mepivacaine, 0.75 mL 2% mepivacaine, or 0.75 mL of a combination of 2% mepivacaine and epinephrine (1:200,000 solution) injected...
Sousa LN, Winter IC, Varela DD, Luvison EZ, Guzmán JFC, Machado AMV, Figueiredo RDV, Pena GT, Dos Santos ACS, Faleiros RR, Carvalho AM.The present study involved seven horses in a randomized crossover clinical trial to evaluate the effect of lidocaine on horses with induced endotoxemia. Horses received intravenous lidocaine (1.5 mg/kg bolus, followed by 0.05 mg/kg bwt/min) or placebo (0.9% sodium chloride at the same manner) one hour before LPS administration (0.03 μg/kg, IV infusion over 30 min). We monitored clinic and hematologic parameters, abdominal auscultation, ultrasound, and pain over time. No relevant clinical differences existed between treatments regarding peristalsis, abdominal pain, or any other parameters befo...
Blum S, Gisler J, Dalla Costa E, Montavon S, Spadavecchia C.Study objective was to evaluate whether the application of a lip twitch could be proposed as conditioning stimulus in the context of a novel Conditioned Pain Modulation (CPM) assessment paradigm for use in horses. The study was a prospective, experimental, randomized trial. Twelve healthy horses were evaluated in two experimental sessions. The lip twitch was used as the conditioning stimulus in both sessions; electrical stimulation was used as the test stimulus in one session, while mechanical and thermal stimulations were used in the other. Differences between thresholds recorded before and d...
Uellendahl A, Schramel JP, Tichy A, Peham C.The aim of this study was to determine whether horses exhibiting unilateral hindlimb lameness unload (rest) the lame limb more than the contralateral limb. The resting/unloading of the hindlimbs and the time spent lying down were measured using accelerometers. Ten non-lame horses and 20 lame horses were recruited for participation and monitored for 11 h overnight with accelerometers (MSR145, sampling rate: 1 Hz, and measuring range: ±15 g) attached to the lateral metatarsal and metacarpal regions of each limb. Metatarsal and metacarpal orientation were used to determine whether the limb was u...
Broman A, Rawlinson JE, Bass L, Boscan P, Rao S.The use of proper sedative and regional anesthetic protocols is essential when performing equine dental surgical procedures under standing sedation. The efficacy of the rostral inferior alveolar nerve block via the mental foramen has not been previously studied. Aims of this study included determining the efficacy of the block, investigating whether any region (labial mucosa, alveolar mucosa, or teeth) was more reliably anesthetized, and if differences in efficacy existed between bilateral and unilateral blocks. In this blinded trial, 10 horses each were randomly assigned to receive a left uni...
Doherty-Sneddon G, Caiazza R, Pawlowska E, Vuong Q.Research has demonstrated the effectiveness of Animal-Assisted Therapy, usually involving dogs, as a way to reduce pain in inpatient and outpatient populations. Here two studies investigate the effectiveness of interacting with horses for reducing human acute pain perception. Unassigned: In Study 1, a blood-pressure cuff was used to administer acute ischaemic pain to 70 adult participants, who were allocated to one of three groups: Equine Assisted Psychotherapy (EAP), Horse Interaction without EAP (HI), and a Control (no horses present). All participants engaged in an activity (finding a horse...
Moyer EK, Bauck AG, Denagamage T, Freeman DE.To compare end-to-side (ES) and side-to-side (SS) jejunocecostomy (JC) in healthy horses. Methods: Experimental study in vivo. Methods: A total of 14 healthy adult horses underwent ventral midline celiotomy, a resection, and either an ES (n = 7) or stapled SS (n = 7) JC. Methods: Surgical times and the external lengths of completed anastomoses were measured. Physical examinations and pain scoring were performed every 6 h for 5 days, then once daily until euthanasia and necropsy 28 days postoperatively. Results: The anastomosis was completed more rapidly (p < .002) with the SS...
King MR, Colla S.Rehabilitation following muscle injury is critical in restoring the equine athlete to full function. Rehabilitation protocols should be tailored to each patient's global functional assessment, taking into account sports-specific demands, goals for return-to-performance, and overall prognosis. Rehabilitation protocols are often designed to modulate pain, enhance repair, improve proprioception, increase flexibility, restore muscle strength, joint range-of-motion, and neuromotor control. This article will review mechanisms of muscle injury, various physical modalities commonly employed in the reh...
King MR, Colla S.Successful rehabilitation of muscle injury requires a comprehensive understanding of the injury process, healing phases, and resources to be employed. The initial phase is characterized by acute inflammatory signs, followed by the regenerative and remodeling phases. Therapeutic exercises can be utilized in all 3 phases, progressing from isometric exercises to aquatic therapies. The classification and phase of injury and the individual response to the applied therapies will guide the progression of the therapeutic exercises through the rehabilitation program.
Alipour-Khairkhah H, Azizi S, Asri-Rezaei S.Donkeys are in the Equidae family but have several differences from horses. There are many studies on the pathophysiology of pain and its clinical signs in horses, but data are limited for donkeys. Therefore, the present study aimed to investigate biochemical effects of flunixin meglumine in donkeys subjected to pain induced by bloodless and surgical castration. Twenty healthy male donkeys were randomly divided into four groups: 1- Surgical castration with flunixin injection, 2- Surgical castration without flunixin injection, 3- Non-surgical castration with flunixin injection, and 4- Non-surgi...
Nowicka B, Polkowska I, Zeliszewska-Duk P, Torres A, Duk M.Similarly, in humans and horses, thoracic and lumbosacral back pain cause more disability and work interruptions worldwide than any other disease. Given that there are few effective treatments for back pain in humans and animals, primary prevention strategies and a reduction in pain factors may be crucial. In the analysed data obtained for the horses studied, the pattern of changes in adipocytokine concentrations, including resistin, visfatin and leptin, was noted for those with back pain compared to the control animals. Concentrations of selected adipocytokines in horses from the back pain gr...
Lundblad J, Rhodin M, Hernlund E, Bjarnestig H, Hidén Rudander S, Haubro Andersen P.Facial expressions in prey animals such as equines can convey information regarding their internal state and are therefore often used as cues for welfare and pain evaluation. The state of pain is commonly compared to a neutral state with little consideration given to other experiences that could affect the animal, although this situation is rare outside of experimental contexts. To evaluate the effect of managerial contexts on facial expressions from a nociceptive input, conspecific isolation and sedation with known physiological effects were compared to compound states of nociception. Using a...
Guo W, Li Z, Mao W, Liu X, Yang Y, Yu J, Yang H, Gao R.Flunixin meglumine (FM) is commonly used in painful conditions in horses; however, it may contribute to equine gastric ulcer syndrome (EGUS). Some veterinarians combine omeprazole (OME) and FM to reduce EGUS risk. However, the efficacy and safety of this combination in Mongolian horses with chronic lameness remain unknown. Objective: To investigate the changes in lameness and EGUS scores in Mongolian horses through the comparison of three treatment strategies: FM, FM + OME and placebo treated control (CON) and to assess the effects of these treatments on gastric fluid pH, serum total prote...
Kemp KL, Yuen NKY, Skinner JE, Bertin FR.Phenylbutazone is prescribed to manage pain caused by hyperinsulinemia-associated laminitis. Phenylbutazone reduces glucose and insulin concentrations in horses with insulin dysregulation (ID) but the underlying mechanism of action is unknown. Objective: Investigate the effect of phenylbutazone on tissue insulin sensitivity in horses. It is hypothesized that the reduced glucose and insulin concentrations in horses with ID receiving phenylbutazone are mediated by a higher tissue insulin sensitivity. Methods: Fifteen light breed horses, including seven with ID. Methods: Randomized cross-over stu...
Guzmán JFC, Gontijo AS, Melgaço ES, Faria SA, Baldi MLC, Sousa LN, Wenceslau RR, Fantini P, Xavier ABDS, Beier SL.Morphine has significant clinical and analgesic effects in horses, but its impact on the gastrointestinal tract requires further understanding. This study assessed the analgesic and gastrointestinal effects of morphine in horses undergoing elective orchiectomy in the quadrupedal position. Thirty uncastrated male horses were randomly assigned to three groups: orchiectomy without morphine and sedation protocol (OSM), orchiectomy with morphine and sedation protocol (OM), and administration of morphine alone in the absence of orchiectomy (M). The anesthetic protocol involved acepromazine (0.05 mg/...
McCarthy RD, Ordóñez HJ, Semevolos SA.To compare core temperatures of superficial and deep digital flexor tendons (SDFT, DDFT) during application of a compression cooling system versus ice boots and during subsequent lower limb bandaging. Methods: Experimental study. Methods: Paired forelimbs of six sedated horses. Methods: Thermocouples were placed in the core of SDFT and DDFT of both front limbs of each horse. A compression cooling system was applied to one front limb and an ice boot was applied to the other front limb for 60 min and then removed for 60 min. Standing bandages were then applied to both front limbs for 60 mi...
de Secondi C, Cantatore F, Marcatili M, Biggi M, Withers J, de Zani D, Zani D.Back pain is a debilitating condition hampering horses' athletic careers. Thoracic spondylosis (TS), a known cause of back pain, leads to osteophytes formation across intervertebral joints. In horses, TS is poorly reported, with anecdotal signs and response to treatment. To report clinical presentation, diagnostic imaging findings, treatment and outcome in horses with TS. The clinical records of horses diagnosed with TS between 2010 and 2023 were reviewed. Signalment, clinical and imaging findings, treatment, and outcome were analysed. Thoracic spondylosis was graded from 1 to 5. Grades, concu...
