Many horses are described as grumpy, aggressive, unwilling, lazy, bad-tempered, or ill-mannered, but what if they are none of those things? Equine pain experts say unwanted behavior is often an attempt to communicate the animal is in pain.
Failure by owners and veterinarians to recognize pain occurs for several reasons: the propensity of horses to conceal pain; a lack of training for veterinarians in evaluating poor performance or low-grade multi-limb lameness, especially in ridden horses; and denial by owners and trainers who may not want to admit that their horses are aging, injured, or unable to compete in a particular event.
"I think one of the biggest challenges for us is equine medicine hasn't really come along as well as small animal medicine, dogs and cats, with regard to recognition of pain as a vital sign and something we should be treating," says Rachel Reed, DVM, DACVAA, associate professor at University of Georgia College of Veterinary Medicine. "For horses, we're a little bit behind on thinking about managing their pain. It's often an afterthought to whatever they are presented for."
Veterinary researchers are seeking improved methods and tools for recognizing and managing pain in horses. Their findings can raise awareness of what pain looks like in horses and help equine veterinarians and horse owners and trainers become more observant and recognize pain earlier so the underlying problem can be identified and treated.
"We have been indoctrinated that some behaviors are normal for horses, but that is not true," says equine orthopedic veterinarian Sue Dyson, MA, Vet MB, PhD, FRCVS. "The problem is we are exposed to too many horses experiencing pain the behaviors have become normalized."
Determining where pain is occurring is not easy. Adam Biedrzycki, BVSc, PhD, DACVS, DECVS, associate professor of large animal surgery at University of Florida, says it is common for veterinarians to film a lame horse, take the video to a veterinary conference, and ask which leg the horse is lame on. Rarely is there unanimous consent on which leg is lame, even among specialists.
"There has been a lot of research into AI lameness tracking and there are lameness locators meant to assist you with that assessment, but they're not foolproof," Dr. Biedrzycki says.
What pain looks like
Dr. Dyson has published more than 430 papers on lameness and diagnostic imaging in peer-reviewed journals, including on development of the Ridden Horse Pain Ethogram,[1] a description of 24 behaviors that can signal musculoskeletal pain in horses under saddle. Horses are very good at concealing lameness, Dyson says, but clues to potential stress or pain include changes in facial expression: ears back, intense stare, tense chewing muscles, change in shape of the muzzle. They also include gait adjustments, such as taking shorter steps; reducing range of motion of the back and increasing the proportion of stride time that each limb spends on the ground, thus sharing the load between limbs; and reducing hindlimb impulsion. Horses with signs of pain at rest may conceal their discomfort in the presence of a person, so 24-hour video surveillance can be revealing.
Veterinarians are trained to recognize obvious lameness but not necessarily to evaluate poor performance or low-grade multilimb lameness, especially in ridden horses, Dyson says. The Ridden Horse Pain Ethogram is a tool they can use to recognize the presence of pain so the horse can then be further evaluated.
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