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15.3.2022: The Ridden Horse Pain Ethogram – Research and Development

Pain Behaviour in Small Animals

It’s not just horses who struggle to communicate their pain issues to humans. It’s common in small animals as well. This study found that many of the dogs and cats seen by vets and behaviourists as having behavioural problems are actually in pain. This could be musculoskeletal pain, but it could also be gastro-intestinal or skin related conditions, for example. The authors recommend ruling out pain, as far as possible, before addressing the issue as behavioural, as opposed to trying to resolve the behavioural problem first. The article includes some fascinating case studies, that really make you think.

Mills, Daniel & Demontigny-Bédard, Isabelle & Gruen, Margaret & Klinck, Mary & Mcpeake, Kevin & Barcelos, Ana Maria & Hewison, Lynn & Haevermaet, Himara & Denenberg, Sagi & Hauser, Hagar & Koch, Colleen & Ballantyne, Kelly & Wilson, Colleen & Mathkari, Chirantana & Pounder, Julia & Garcia, Elena & Darder, Patrícia & Fatjó, Jaume & Levine, Emily. (2020). Pain and Problem Behavior in Cats and Dogs. Animals. 10. 318. 10.3390/ani10020318

You can access the full article for free here.

Simple Summary

The potential role of pain in problem behavior is widely acknowledged, but there seems to be a lack of reporting of this issue. It is difficult to present definitive evidence concerning the breadth of the problem given the individuality of problem behavior. In this commentary, we present evidence from our own caseloads to illustrate the scale and the nature of the issue with a view to increasing awareness of the problem by veterinarians, non-veterinary behaviorists, and owners. Among the referral caseloads of several of the authors, the prevalence in recent years ranges from 28–82%, and many of these conditions can be suspected from close observation of the patient. While the actual mechanism underpinning the association between pain and problem behavior may never be known in a given case, we suggest the relationship between the problem behavior and pain can be classified into one of four categories: the presenting complaint is a direct manifestation of pain; unidentified pain is underpinning secondary concerns within the initial behavior problem; there is an exacerbation of one or more signs of problem behavior as a result of pain; or adjunctive behavioral signs are associated with pain. We conclude that, in general, it is better for veterinarians to treat suspected pain first rather than consider its significance only when the animal does not respond to behavior therapy.


We argue that there is currently an under-reporting of the ways in which pain can be associated with problem behavior, which is seriously limiting the recognition of this welfare problem. A review of the caseloads of 100 recent dog cases of several authors indicates that a conservative estimate of around a third of referred cases involve some form of painful condition, and in some instances, the figure may be nearly 80%. The relationship is often complex but always logical. Musculoskeletal but also painful gastro-intestinal and dermatological conditions are commonly recognized as significant to the animal’s problem behavior. The potential importance of clinical abnormalities such as an unusual gait or unexplained behavioral signs should not be dismissed by clinicians in general practice, even when they are common within a given breed. In general, it is argued that clinicians should err on the side of caution when there is a suspicion that a patient could be in pain by carefully evaluating the patient’s response to trial analgesia, even if a specific physical lesion has not been identified.

Dr Sue Dyson and I are in the process of writing a book for horse owners and riders on how to understand and use the Ridden Horse Pain Ethogram with your own horse. The book will be published by J A Allen, and available sometime In 2023. Sign up to my newsletter at for updates.

In the meantime, you can learn more about the Ridden Horse Pain Ethogram through listening to Dr Sue Dyson explaining here it on the Equine Veterinary Education, where you can also listen to her discussing many of the other studies that she has been involved in. You can also take an online course with Equitopia.

© Sue Palmer, The Horse Physio 2021

Treating your horse with care, connection, curiosity and compassion

March 15, 2022
Sue Palmer