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 […]
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 ...
Kuroda T, Knych HK, Noble GK, Minamijima Y, Leung GN, Nomura M, Mizobe F, Ishikawa Y, Kusano K, Toutain PL.Flunixin meglumine is widely used to manage pain and inflammation in horses, and its regulation requires robust pharmacokinetic analysis for harmonization. In this study, we conducted a meta-analysis of flunixin disposition using plasma and urine concentration data from 65 horses across four countries to robustly estimate pharmacokinetic parameters in setting screening limits (SLs) for controlling medications in horses. A population (POP) model was developed using nonlinear mixed-effects model analysis. The irrelevant plasma concentration (IPC) and irrelevant urine concentration (IUC) were det...
Klinck M, Lovett A, Sykes B.Equine gastric ulcer syndrome (EGUS) refers to mucosal gastric disease in horses, including equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD), which present as two distinct disease entities differing in pathophysiology and approach to disease management. Both diseases are a source of pain in affected horses, partly explaining why EGUS continues to receive substantial attention in the equine medical, welfare and equitation research sectors. There is a complex interplay between EGUS and a variety of physical and psychological stressors. Horses with EGUS are often...
Purnama MTE, Fikri F, Çalışkan H, Wicaksono AP.Racehorses endure high physical demands, which often result in musculoskeletal pain, fatigue, and reduced performance. Although conventional therapies are effective, competition-related drug regulations restrict their use. Acupuncture, rooted in Traditional Chinese Veterinary Medicine, has gained interest as a non-pharmacological alternative for managing pain, enhancing recovery, and promoting overall welfare in equine athletes. This review aims to critically evaluate the current evidence on the efficacy of acupuncture in racehorses, focusing on musculoskeletal pain management, post-exercise r...
Stokes C, Natalini CC, Wills R, Eddy A, Mochal-King C, O'Shea C, Fontenot RL.To evaluate the analgesic properties and adverse effects of liposomal bupivacaine administered via caudal epidural in horses. Methods: Pharmacodynamic study. Methods: A total of 10 healthy adult horses. Methods: Liposomal bupivacaine (10 mL; 1.3%) was administered into the caudal epidural space via an indwelling epidural catheter inserted to a length of 15 cm. Mechanical nociceptive threshold (MNT) testing with pressure algometry was used to measure analgesia at four anatomic locations for 72 h following injection. Physical examinations (including rectal temperature, heart rate, respirat...
Curry O, Everett A, Pearson G, Dwyer C, Duncan J.Despite the availability of several equine pain assessment tools, their use in equine veterinary practice appears limited compared to small animal practice. This study explores potential barriers to equine pain assessment, as reported by staff at a single UK equine teaching hospital. Methods: Nine hospital staff members were interviewed using semi-structured interviews. Key themes were identified through reflexive thematic analysis. Results: Participants acknowledged the importance of pain assessment, yet highlighted limitations in current methods and their inconsistent use. Key challenges inc...
Jandová V, Huber N, AlMheiri FG, Bábor K, Trachsel DS.Stress represents a serious health and welfare concern; however, its objective assessment remains difficult. The equine gastric ulcer syndrome (EGUS) and orthopedic diseases that cause pain are among stress associated diseases in equine medicine. The leukocyte coping capacity (LCC) quantifies oxygen radical generation of neutrophil granulocytes which is altered under stress. Therefore, LCC could be a novel biomarker for stress in horses and we hypothesized that horses with stress associated diseases would have lower LCC values in comparison to horses without these diseases. Methods: In this ob...
Bolesławska-Szubartowska J, Kucharczuk M, Skrabska A, Zbysław A, Adamowicz J, Alszko A, Domagalska-Stomska K, Durska M, Dziekcierów A....Pain after giving birth is commonly observed in horses, yet there has not been a specific tool developed for assessing this pain in postpartum mares. The goal was to adapt existing equine pain scales and to preliminarily validate a practical pain scale for use by veterinarians and caregivers after foaling. Methods: The pain scale was developed by adapting items from other pain scales, including established orthopedic and colic equine pain scales, and incorporating caregiver feedback. The final scale includes eight areas for assessing pain: behavior, facial expressions, vital signs, udder exami...
Hargitaiova K, Maleas G.To describe outcomes following high-metacarpal deep digital flexor tenotomy (DDFT) combined with Steward clog application in horses and ponies with refractory chronic laminitis. Methods: Retrospective observational study. Methods: Client-owned horses and ponies (7 horses, 8 ponies) with severe refractory laminitis. Methods: Medical records (2018-2019) were reviewed. All underwent standing high-metacarpal DDFT tenotomy proximal to the accessory ligament (AL-DDFT) junction, followed by customized Steward clogs application. Preoperative assessment included radiography and venography. Postoperativ...
Leibeck R, Lehman J, Birmingham S.Whole-body vibrational therapy (WBV) is well-studied in people, but there is a paucity of research regarding its effect on horses. It is suggested that the use of WBV in horses increases performance, aids in recovery, and stimulates nerves, bones, and muscles in ways that normal exercise does not. Objective: The purpose of this pilot study was to determine if frequent WBV therapy sessions affect mechanical nociceptive thresholds based on pressure algometry in horses without clinical signs of lameness or back pain. Methods: The mechanical nociceptive thresholds (MNTs) were measured for 5 horses...
Briefer-Freymond S, Dalla Costa E, Jolivald A, Bruckmaier RM, Atallah E, Giorgia Riva M, Ijichi C.Personality affects both experience and expression of pain and the welfare impact of castration on horses is poorly understood. Therefore, the current study observed 19 horses to determine: the welfare impact of standard castration on horses; whether individuals consistently vary in their behavioural and emotional responses to pain; the influence of personality on behavioural and physiological responses to pain; whether Horse Grimace Scale (HGS) indicates how individuals feel about painful experiences. Eye temperature (IRT), salivary cortisol, HGS and a pain ethogram were measured at intervals...
Weber LA, Oltmanns H, Chiavaccini L, Pickles KJ, Roberts V, Kloock T, Niebuhr T, Feige K.Trigeminal-mediated headshaking (TMHS) in horses shares clinical features with human trigeminal neuralgia (HTN). Increased levels of the neuropeptide calcitonin gene-related peptide (CGRP) have been found in the blood and cerebrospinal fluid (CSF) of HTN patients. Inhibition of CGRP in humans has shown promise for pain relief. Data on CGRP in horses affected by TMHS are currently lacking but if quantifiable and validated, could assist in developing new diagnostic and more rational therapeutic approaches. Objective: This study aimed to quantify and correlate CGRP concentrations in the serum and...
Qiu Z, Wang J, Zhang Y, Liu X, Wei C, Ma T.Musculoskeletal injuries represent a primary cause of suboptimal performance and early retirement in equine athletes. To address this challenge, the veterinary community has long endeavored to develop safer and more effective therapeutic strategies. Extracorporeal shock wave therapy (ESWT), as a treatment for equine musculoskeletal injuries, has garnered substantial attention among equine veterinarians. Focused on the theme ESWT Therapy for Equine Musculoskeletal Disorders: From biological mechanisms to clinical applications, this article systematically reviews existing literature on the biolo...
Teysen S, Demey W, Menzies R, Staszyk C, Birkhed D, Lundström T.The injection of a local anaesthetic into the periodontal ligament (PDL) to achieve desensitisation of the pulp, periodontium, and adjacent tissues is a well-established technique in human dentistry, particularly in paediatric patients. This approach, commonly referred to as intraligamental or intraligamentary anaesthesia (ILA), has been widely adopted due to its effectiveness and relative simplicity. The aims of the present publication were: (1) to provide a review of the literature, (2) to describe an ILA technique adapted by the authors for use in equine dentistry, and (3) to evaluate this ...
Ajeebsanu MM, Koshy SA, Karakka Kal AK, Subhahar MB, Karatt TK, Philip M.Suzetrigine, a recently approved Na1.8 sodium channel blocker, shows strong potential in the treatment of neurological, psychiatric, and pain-related conditions. Its peripheral selectivity enables effective pain management while avoiding central nervous system complications and addiction risks linked to opioid use. Following FDA approval in January 2025, concerns have emerged regarding its possible misuse for performance enhancement in sports, highlighting the need for reliable detection tools in doping control. Methods: An analytical procedure was designed and validated to detect suzetrigine ...
Domańska-Kruppa N, Benoit P, Żukiewicz-Benoit K, Domino M, Kliczkowska K, Szubart M, Stefanik E.Limited data is available on the diagnostic and therapeutic methods for pathologies caused by scarring after castration. It is well recognized that specific behaviors or untypical hindlimb lameness may be observed in geldings with gelding scars and adhesions caused by spermatic cord remnants after castration OBJECTIVES: To describe how to diagnose movement disorders associated with excessive adhesions caused by spermatic cord remnant after castration and to present a successful surgical treatment method. Methods: To assess the impact of gelding scars on horses' movement and behavior, medical r...
Damasceno KFA, Mouta AN, Alves LSA, Arcoverde KN, Aragão HR, Cavalcante JM, Veras de Paula V.Remifentanil and xylazine are used as continuous infusions to facilitate standing surgery in horses. Their use for this purpose has not been reported in donkeys. Objective: To evaluate the behavioural, sedative, and cardiorespiratory effects of continuous intravenous infusion of remifentanil and xylazine in donkeys. Methods: Non-blinded in vivo experiments. Methods: Ten donkeys were sedated with an intravenous bolus of xylazine (0.8 mg/kg). After 3 min, continuous infusions of xylazine (0.65 mg/kg/h) and remifentanil (6 μg/kg/h) were administered for 60 min. Cardiorespiratory physio...
Lizarraga I, Castillo-Alcala F.Donkeys have contributed to the development and livelihoods of humans for almost 7,000 years. They have been used for traction and transportation, kept as pets, utilized in animal-assisted therapies, or farmed as food-producing animals. Over the past two decades, significant progress has been made in bridging the knowledge gap in veterinary medicine between donkeys and horses. Veterinary practitioners are now more aware that donkeys have important behavioral, anatomical, and physiological characteristics that distinguish them from horses. These peculiarities should be considered when treating ...
Hellige M, Geburek F.A number of indications exist that necessitate radiologic examination of the equine cervical spine. Different neurologic and pain-associated clinical signs within the scope of lameness or poor performance may be associated to pathologies of the cervical spine. Moreover, the number of requests for radiographic examinations of the cervical spine, for example as part of the pre-purchase examination, has increased significantly in recent years. However, the interpretation of radiographs represents a challenge, particularly in the case of clinically sound horses, as it often necessitates the resolu...
