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.
This article provides an overview of initial assessment and management of common emergency presentations in donkeys and mules. The principles are similar to those in horses (and ponies), but clinicians must be aware of differences in recognition of signs of pain/disease, approach to handling, pharmacology of some drugs, and subtle differences in the physiology and local anatomy in donkeys and mules. The epidemiology of common disease presentations will vary between pet/companion or working/farmed donkeys and mules. Regular dental checks, deworming, vaccination, and monitoring of behavior and q...
This study presents the validation of two recently described pain scales, the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP), in horses with acute colic. A follow-up cohort study of 46 adult horses (n = 23 with acute colic; n = 23 healthy control horses) was performed for validation and refinement of the constructed scales. Both pain scales showed statistically significant differences between horses with colic and healthy control horses, and between horses with colic that co...
Initial treatment of colic is aimed at maintaining hydration and acid-base balance, controlling pain and reestablishing peristalsis. A poor response to medical treatment in the first 12-18 hours suggests the need for laparotomy. Other indications for surgery include: rising pulse rate, exceeding 60/minute for several hours; congested mucosae; delayed capillary refill; silent abdomen; gastric reflux; distended or displaced loops of bowel on rectal examination; intractable pain; and adverse laboratory findings. Postoperative care should consist of hand-walking for 30 days, followed by confinemen...
The objective of this study was to compare effects of butorphanol (BUT) or buprenorphine (BUP), in combination with detomidine and diazepam, on the sedation quality, surgical conditions, and postoperative pain control after cheek tooth extraction in horses, randomly allocated to 2 treatment groups (BUT: = 20; BUP: = 20). A bolus of detomidine (15 μg/kg, IV) was followed by either BUP (7.5 μg/kg, IV) or BUT (0.05 mg/kg, IV). After 20 min, diazepam (0.01 mg/kg, IV) was administered and sedation was maintained with a detomidine IV infusion (20 μg/kg/h), with rate adjusted based on scores to ...
The research article describes the treatment, recovery process, and prognosis of a 2-month old Quarter Horse, who suffered from severe lameness in the left forelimb due to an avulsion-type fracture […]
Cole RC, DeGraves FJ, Brown J, Schumacher J.To compare the effect of 2.5 mL 2% mepivacaine to the effect of 0.5 mL 2% mepivacaine administered over each palmar digital nerve, as an abaxial sesamoid nerve block (ASNB), to 6 horses lame because of naturally occurring digital pain. Unassigned: In a crossover study design with 3 horses in each group, the trotting gait of the horses was analyzed with an inertial sensor-based, motion-analysis system (Q with Lameness Locator; Equinosis LLC) immediately before and after treatment with either 0.5 or 2.5 mL mepivacaine administered over each nerve near the base of the proximal sesamoid bone of th...
Rodrigues APDC, Pozzobon R, De Bastiani G, De La Côrte FD, Azevedo MDS.Lameness, which arises from functional or structural changes in the limbs or axial skeleton, causes asymmetry in the movement of the equine head and/or pelvis. This study aimed to investigate the lameness patterns of horses that underwent lameness examination or monitoring during the years 2016 to 2020. This retrospective study used data from the lameness examination, evaluated using an objective assessment with body-mounted wireless inertial sensors. The lameness examination comprised clinical history, static inspection, palpation, gait evaluation (for which the animals were equipped with a w...
Quam V.Inflammation plays a role in acute and chronic equine tendon/ligament injury; anti-inflammatories are often indicated. Local corticosteroids provide consistent and profound short-term effects on pain and inflammation across species. However, there is no demonstrated benefit in the long term, and complications can occur. Alternative biologic anti-inflammatory treatments are available and should be used in horses at risk of complications. Nonetheless, corticosteroids remain an affordable and effective anti-inflammatory that, with continued research, may be indicated on a case-by-case basis as pa...
Patricio CR, Winter GHZ, Garbade P.Spinal articular dysfunction disrupts normal neural function and may lead to stiffness, pain or poor performance. Back pain is common in equine athletes, and it is a common complaint by horse owners requesting chiropractic evaluations. Objective: To describe the prevalence of spinal articular dysfunction in showjumping horses. Methods: Retrospective analysis of clinical records. Methods: Records from 3 years of examinations in horses, from beginners to high-performance levels. Each horse had 30 spinal segments evaluated for the presence of dysfunctional articulations. Exams were performed by...
Moody LM, Hicks SL, Foote BC, Hendrix DV, Ward DA.Equine corneal disease is common and painful. Current pain mitigation strategies are often suboptimal, especially early in the disease. Objective: To evaluate the effects of local anaesthetic delivery via indwelling retrobulbar catheter on corneal sensitivity, pupil size, pupillary light responses (PLRs), and ocular motility in normal horses. Methods: Randomised, controlled crossover experiment. Methods: One eye was randomly selected from seven horses. A 20-gauge catheter was placed in the retrobulbar space and injected with 10 mL of 0.5% bupivacaine or 0.9% saline. Cochet-Bonnet esthesiomet...
Calle-González N, Rivero JL, Olivares J, Miró F, Argüelles D, Requena F, Munoz A.Capacitive-resistive electrical transfer (CRET) is an endogenous non-invasive technique, used as deep diathermy. We pursue to analyze the temperature changes by applying different CRET protocols in the thoracolumbar spine of horses, between thoracic vertebrae 15 and lumbar 2. Unassigned: Ten clinically sound horses without thoracolumbar pain underwent various CRET protocols applied to a standardized thoracolumbar region (T15-L2). The protocols included sham (device off), low intensity (LIP, 5%), medium intensity (MIP, 30%), and high intensity (HIP, 40%). The HIP protocol was further divided in...
Kelemen Z, Vogl C, Torres Borda L, Auer U, Jenner F.Clinical care for patients with limited life expectancy often requires adjustments, prioritizing immediate benefits over long-term outcomes, as the relevance of future complications diminishes. This study identifies indicators of mortality risk in horses with chronic orthopaedic conditions to enhance individualized care and welfare. Over 3 years, 123 chronically lame horses and 6 healthy control horses at an animal sanctuary underwent regular (every 3 months) comprehensive health assessments and activity monitoring using wearable sensors. Data collected included body condition scores, muscul...
Uldahl M, Mellor DJ.This commentary evaluates contemporary equestrian sport governance through the lens of equine welfare science. Drawing on evidence from the FEI Sport Forum 2025 debates, the IFHA Racing Integrity Handbook, media coverage of horse sport, recent scientific presentations, regulatory texts, and published research, we identify systemic shortcomings in how horse welfare is assessed, prioritised, and protected. Key issues include reliance on performance as a proxy for welfare, inadequate "fit-to-compete" protocols, neglect of horses' mental states, coercive tack and equipment practices (e.g., double ...
Calatayud-Bonilla M, Carmona JU, Prades M.Myofascial pain syndrome (MPS) is caused by trigger points (TrPs): hypersensitive spots in taut muscle bands that impair function and cause pain. Dry needling (DN) is a common treatment in humans, but evidence in horses is limited. This prospective, controlled study evaluated the effectiveness of DN in reducing TrP-related pain in the brachiocephalic muscle of horses. Of the 98 horses enrolled, 66 were allocated to a treatment group receiving weekly DN sessions for three weeks, while 32 were assigned to a control group with no intervention. Pain and function were assessed using pressure algome...
Jastrzębska E, Dobbek D, Pawłowska A.Back pain in horses is a frequent musculoskeletal issue that affects performance and welfare. Magnetotherapy has been proposed as a complementary, non-invasive treatment to reduce pain and support soft tissue recovery, but studies in horses remain limited. This pilot study aimed to evaluate the effects of low-frequency pulsed magnetic field therapy on horses with hypersensitivity to palpation along the longissimus dorsi muscle. Four recreational horses participated in a 10-session magnetotherapy program, with changes assessed using palpation, neck flexibility tests, heart rate measurements and...
Mendoza Flores JE, Terrazas A, Lara Sagahon AV, Aleman M.Parasympathetic tone activity (PTA) and its association with behavior in conscious versus anesthesia in horses are unknown. Objective: To study PTA, heart rate (HR), minimum alveolar concentration (MAC), and mean arterial pressure (MAP) during castration under anesthesia. To study PTA, HR, Horse Grimace Scale (HGS), locomotor activity (LA), and behavior in conscious horses before and after castration. Methods: Pilot study including seven healthy adult horses. After habituation (days 1, 2, and 3), PTAm, HR, HGS, LA, and behavior were investigated during pre-surgery (days 4-, 5-, and one-hour pr...
Knickelbein KE.Numerous ocular diseases cause visual impairment and induce ocular pain that may be associated with undesired behaviors in horses. Horses with ocular pain, indicated by the presence of blepharospasm, blepharoedema, ocular discharge or rubbing the eye, should be rested from work to avoid worsening the ocular disease and to avoid undesired behaviors associated with pain or vision impairment. Horses with ocular disease are frequently head shy. Some stoic horses may not have obvious outward clinical signs despite significant visual impairment, and as such, undesired behaviors such as spooking, bal...
Whitelock A, Goodwin W, Dryburgh L, Mshelbwala PP, Rae L, Marwedel L, Lok T, Kemp K, Stewart AJ.To describe Australian practices and attitudes regarding equine analgesia. Methods: Cross-sectional anonymous, voluntary survey of Australian veterinarians treating equine patients. Methods: Australian veterinarians in equine or mixed practices completed a six-section, 60-question survey between November 2019 to August 2020. Information was gathered on demographics, analgesia prescription, pain assessment and attitudes surrounding specific analgesics. Respondents assigned a pain score ranging from 0 to 10 for various conditions; these were averaged to give each respondent an "average pain scor...
Copelin C, Merkies K.Equestrian sport's social license to operate has come under scrutiny due to concerns surrounding the well-being of ridden horses. Inappropriate equipment use, such as harsh bits or overtight nosebands, can negatively influence well-being by generating inescapable pressure or pain on the sensitive structures of the horse's head and limiting natural behaviours. Restrictive equipment may also be used to generate exaggerated, stressful and uncomfortable head and neck positions such as hyperflexion. Saddles must be properly fitted to both horse and rider to ensure appropriate distribution of kinema...
Hoogelander B, Frippiat T, Bergman HJ, Vanderperren K, van Veggel ECS.Thoracolumbar congenital abnormalities are considered rare in mature, performing horses. This case report describes a 14-year-old Welsh pony presented with marked epaxial muscle atrophy, mid-thoracic spinal pain, and stiffness, most pronounced during canter. The thoracic spine exhibited scoliosis, centered at T9-T10, and kyphosis. Radiography and postmortem computed tomography revealed complex congenital malformations of the thoracic vertebral column, including abnormal morphology of the T10-T12 vertebral bodies, partial vertebral fusion, a malformed spinous process, a malformed rib with assoc...
Schmidt S, Swagemakers JH, le Jeune SS.The cervical vertebral column in horses plays a crucial role in movement, posture, and performance and disorders affecting it can cause pain, ataxia, or lameness. This review discusses major acquired (traumatic, infectious, neoplastic) and degenerative (osteoarthritis, foraminal stenosis, intervertebral disc disease) conditions. Acquired lesions often arise from trauma, bacterial infection, or neoplasia, with clinical signs ranging from neck pain to neurologic deficits. Degenerative disorders, particularly osteoarthritis of articular process joints, are common in the caudal cervical spine and ...
Zimmerman-Cameron SR, Colbath AC, Caruso MA, Hoffman RM, Logan AA.Navicular syndrome is characterized by palmar foot pain and is a common cause of lameness in horses. Palmar digital neurectomy (nerving) removes sensation to the heel region of the hoof and may serve as a treatment for navicular-afflicted horses, while analgesia (blocking) results in temporary loss of sensation. Objective: The purpose of this pilot study was to examine the effect of loss of sensation in the heel on the forelimb area and force while tracking on soft and hard ground at the walk and trot. Methods: Three horses that scored a 0 or 1 on the AAEP lameness scale were fitted to Tekscan...
Aleman M, Morales CJ.Idiopathic trigeminal-mediated headshaking is a painful neuropathic disorder characterized by sudden, violent, predominantly vertical head movements of unknown etiology. Clinical signs may be seasonal or persistent and triggered by light, sound, exercise, or tactile nasal stimulation. The pathophysiology is multifactorial, involving abnormal trigeminal nerve excitability influenced by hormonal, environmental, and dietary factors. Treatment is challenging and typically multimodal, aiming to reduce trigeminal hypersensitivity and improve quality of life.
Lenarz J, Smit IH, Rhodin M, Lischer C, Fugazzola MC.Intramuscular vaccination is a routine component of equine medicine, but local muscle soreness may transiently affect gait symmetry. Objective data on vaccination-associated gait changes in horses are lacking. Objective: To investigate whether intramuscular vaccination induces measurable gait asymmetries depending on injection site, to inform recommendations on vaccination site selection and short-term exercise management. Methods: In this prospective, randomised, blinded, placebo-controlled study, eighteen clinically sound Warmblood horses were enrolled and received an intramuscular vaccinati...
Slavik K, Underwood C, Lowndes C, Skelton G, van Eps A.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...
de Luna Paiva TD, de Melo Lopes AR, Silva ÁJC, Figueiredo MAF, da Cunha Nogueira SS, Nogueira-Filho SLG.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). ...
Carroll AT, Reed RA, Berghaus LJ, McNabney D, Knych HK.To investigate the effect of cannabidiol (CBD) on thermal and mechanical thresholds and physiologic variables in horses. Unassigned: 6 horses (3 geldings and 3 mares) were enrolled in a prospective, randomized, masked crossover design from March 18 through May 3, 2025. Horses received 3.48 mg/kg CBD oil or placebo (sesame oil) orally every 24 hours for 3 days. Thermal and mechanical thresholds were determined at baseline and 4 and 12 hours after treatment administration on each day. Physiologic variables, including heart rate, respiratory rate, and rectal temperature, were recorded at the same...
Amari M, Brioschi FA, Auletta L, Ravasio G.Radiofrequency ablation (RFA) and pulsed radiofrequency (PRF) are non-pharmacological techniques employed in humans for chronic pain, but their veterinary application is unexplored. This pilot study evaluated clinical effects of RFA and PRF in twenty-four horses with chronic distal forelimb lameness. Ultrasound-guided RFA (N = 8; 60-90 °C, 2-8 min) or PRF (N = 16; 42 °C; 12 min) was applied to palmar digital nerves. Lameness was scored (American Association of Equine Practitioners scale) at baseline and monthly for six months (T1-T6). At T2, partial- and non-responders in both groups receive...
Willette J, Guinn A, Munsterman A.Impactions of the jejunum are rarely described in the literature. The current case series describes six cases of adult horses with jejunal impactions with feed material diagnosed by exploratory celiotomy. Horses underwent exploratory celiotomy based off of their degree of pain despite medical management and concerns for a primary strangulating small intestinal lesion. All jejunal impactions were relieved via manual decompression of the impaction into the cecum. None of the cases underwent a resection or anastomosis at the site of impaction. All horses were treated with gastroprotectants (omepr...
Amiet B, Rainger J, Zedler S, Stewart A, Woldeyohannes S, Goodwin W.To compare horses' aversive behavioural responses to the application of 5% prilocaine/lidocaine eutectic mixture of local anaesthetics (EMLA) cream versus subcutaneous infiltration of 2% lidocaine, followed by jugular vein catheterization. Methods: Blinded, randomized study. Methods: A group of 26 university-owned research horses. Methods: Each horse received both treatments at opposite jugular sites with ≥ 12 hours between procedures. One randomly assigned jugular site received 1 g cm of 5% EMLA cream 60 minutes before catheterization, while the contralateral site received 1.5 mL of 2% lido...
Marques GF, Moorman VJ, Ellis KL, Perlini M, Edwards VL.To describe the long-term outcome of a horse that underwent a standing, ultrasound-guided, minimally invasive, biceps brachii tenotomy. Methods: Case report. Methods: A 17-year-old Tennessee Walking Horse gelding. Methods: The horse had a chronic, severe, lameness localized to the left shoulder region. Diagnostic imaging revealed fractures of the intermediate and lesser tubercles of the left humerus, biceps brachii (BB) tendinopathy, and bicipital bursitis. Conservative management was attempted, but lack of improvement prompted surgical intervention. An ultrasound-guided, minimally invasive, B...
Smith R, Perkins L, Pinchbeck G, Ireland J.The decisions made by horse owners on behalf of their animal, including decisions to involve a veterinarian, play an important role in the management of pain. This study explored horse owners' experiences to understand how they conceptualised chronic pain within the context of their horse-human relationship, what led them to seek veterinary involvement, and how veterinary interactions shaped their perceptions of pain and its management. An ethnographic approach using constructivist grounded theory methods was adopted. This paper draws upon field notes generated through 200 h of observation und...
Pilati N, Pressanto MC, Palumbo Piccionello A, De Angelis Corvi F, Beccati F.The term overriding spinous processes (ORSPs), commonly known as "kissing spine syndrome," refers to a skeletal abnormality in horses that is characterized by the narrowing (<4 mm) of the interspinous space and touching or overlapping of the spinous processes (SPs). This condition primarily affects the mid- and caudal thoracic vertebrae; however, ORSP can also affect the lumbar SPs. In the veterinary community, kissing spine is widely recognized as a common condition in sport horses, as it is often associated with chronic back pain and contributes to poor performance. Despite its significant c...
Edwards VL, Reed R, Perlini M, Moorman VJ.To determine the analgesic effects of detomidine and morphine administered by cervical epidural catheter (CEC) on a model of thoracic limb pain. Methods: Prospective, randomized, blinded crossover study. Methods: Five adult horses. Methods: Cervical epidural catheters were placed under ultrasound guidance, followed by induction of lipopolysaccharide (LPS)-mediated carpal synovitis. Horses received either saline or detomidine/morphine (DM; 10 μg/kg, 0.1 mg/kg, respectively) via CEC 4 h after synovitis. After a 7 day washout, synovitis was induced in the contralateral carpus, and the alternate ...
