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Pain Management In Horses

Pain is an essential for survival. However, we know that sometimes we have to cause pain to horses, for example through surgery. And we know that there are various other ways in which horses end up in pain. What’s more difficult is how we recognise that pain, and how we manage it. The important aspects of pain management are to understand it, assess it, prevent it, and treat it. Presently, our best approach to assessing pain in horses, and their response to painkillers and anaesthesia, is through their behaviour and expression. This review of pain management in horses advises that wherever possible, we prevent pain (for example, during surgery).

Guedes A. Pain Management in Horses. Vet Clin North Am Equine Pract. 2017 Apr;33(1):181-211. doi: 10.1016/j.cveq.2016.11.006. PMID: 28325179.

You can access the full article here.

Key Points

  • Physiologic pain is a multidimensional experience (sensory and emotional) that is vital for survival, but becomes a problem when painful medical practices need to be performed.
  • Tissue injury amplifies physiologic pain and can evolve to a state of pathologic pain if not appropriately managed.
  • At the present time, monitoring changes in equine behavior and expression appears to be the best approach for assessing pain and response to analgesics.
  • Surgery is one of the only situations in which the nature, location, and extent of tissue injury are precisely known in advance, and an appropriate analgesic protocol can be formulated and established.
  • Pain therapy should focus on prevention as much as possible and include a multimodal approach with pharmacologic and nonpharmacologic strategies.


There has been great progress in the understanding of basic neurobiologic mechanisms of pain, but this body of knowledge has not yet translated into new and improved analgesics. Progress has been made regarding pain assessment in horses, but more work is needed until sensitive and accurate pain assessment tools are available for use in clinical practice. This review summarizes and updates the knowledge concerning the cornerstones of pain medicine (understand, assess, prevent, and treat). It highlights the importance of understanding pain mechanisms and expressions to enable a rational approach to pain assessment, prevention, and management in the equine patient.

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 2, 2022
Sue Palmer