Pain Management in Horses, Horse care

Pain Management in Horses

Why is pain management Important?

  • Freedom from pain is an essential part of horse welfare.
  • Pain management plays an important role in recovery from injury or illness. In humans, the benefits of adequate management include fewer complications, earlier discharge from hospital and reduction in the development of chronic pain syndromes.
  • Pain can have a negative impact on behavior and performance.

How do you know if your horse is in pain?

Detection of pain is crucial – if we can’t detect it then we can’t manage it effectively. However, recognising pain in horses can be challenging. Horses are prey animals and are instinctively programmed to hide their vulnerability to predators. Horses are also known for their individual variation in displaying signs of pain. For example, highly anxious or temperamental horses such as thoroughbreds may be more likely demonstrate intense pain than calm, ‘relaxed’ horses.

Evaluation of pain in horses therefore requires careful interpretation of abnormal, pain related behaviour.

Signs that your horse is in pain

Manifestations of pain in horses can be subtle and non-specific, but signs you should look for include:

  • Behavioural changes: restlessness, agitation, headshaking, dullness or depression, signs of aggression, decreased interaction with surroundings
  • Change in posture or movement: altered stance, arched back, reluctance to move, lowered head carriage, stretching, weight shifting or pawing
  • Change in appetite: loss of interest in food, playing with water, slow chewing or dropping feed
  • Change in facial expression: fixed stare with wide nostrils and clenched facial muscles

Sometimes signs of pain can be more specific and can relate to the underlying problem:

  • Colic pain: rolling, flank watching, kicking at the abdomen, pawing, stretching, groaning
  • Lameness: weight-shifting between limbs, abnormal weight distribution, pointing, hanging and rotating of the limbs, abnormal movement, and reluctance to move or work. Horses with laminitis have a typical stance of leaning backwards and have a ‘pottery’ gait.
  • Ocular pain: holding the eye closed, upper eyelashes pointing downwards, increased tear production or discharge from the eye, sensitivity to bright light.
  • Dental Pain: dropping food, slow chewing, reluctance to eat, pocketing or pouching of food in the checks, head tilting or nodding or an abnormal head carriage, problems with acceptance of the bit.

How we can help to manage your horse’s pain?

The methods used to manage your horse will depend on the duration, type and severity of the pain. Diagnosis and treatment of the underlying problem is the first step and a short course of pain relief is often required while this is undertaken. However in cases of chronic pain, longer term or indefinite treatment may be needed to manage the patient’s comfort and improve their quality of life. The most common example of this is horses with osteoarthritis. In horses undergoing long term treatment, health checks must be performed every 6 months (or more frequently in some cases) to ensure that the prescribed dosage is still appropriate and to check for adverse side effects.


Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drug for pain management in horses. Examples include bute (e.g. Equipalazone), flunixin (e.g. Equinixin or Finadyne) and meloxicam (e.g. Metacam). These medications relieve pain and help in the reduction of inflammation and fever. They can be given orally as well as by injection and are frequently used in the management of osteoarthritis, among many other conditions.

As with any medication, however, these drugs can have side effects and it is important to balance the benefits of treatment with the risk of side effects. Side effects of NSAIDs include gastrointestinal disease (such as stomach ulcers, colon ulcers and diarrhoea) and kidney damage. The risk of side effects is increased in sick or dehydrated horses. Clinical signs of toxicity include loose droppings, colic, ulceration of the gastrointestinal tract (seen as low protein and/or anaemia on blood work or as ulcers on an endoscopic examination), poor hair coat, increased drinking or urination and weight loss. If you notice any of these signs in your horse, the medication should be stopped and you should speak to your vet.

Other Options

Other pain relief options are available and are often used in combination with NSAIDs. Some of these can be given orally whereas others can be given only by injection from your veterinary surgeon. Using multiple classes of drugs can improve pain relief while decreasing the risk of side effects. In addition to medical therapy, methods such as physiotherapy, weight management, acupuncture and remedial shoeing can all play a role in the management of pain in your horse.

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