30/06/2025
๐๐๐๐ฃ ๐๐๐ฃ ๐๐ ๐ค๐ฃ๐ ๐ค๐ ๐ฉ๐๐ ๐ข๐ค๐จ๐ฉ ๐๐๐๐ง๐ฉ๐๐ง๐๐๐ ๐๐ฃ๐ ๐ฉ๐๐๐ฃ๐๐จ ๐ฉ๐ค ๐ฌ๐๐ฉ๐๐ ๐ค๐ช๐ง ๐๐ค๐ง๐จ๐ ๐ค๐ง ๐ฅ๐ค๐ฃ๐ฎ ๐๐ญ๐ฅ๐๐ง๐๐๐ฃ๐๐, ๐ฅ๐๐ง๐ฉ๐๐๐ช๐ก๐๐ง๐ก๐ฎ ๐ฌ๐๐๐ฃ ๐ฌ๐ ๐๐๐ฃโ๐ฉ ๐๐๐๐ช๐ง๐๐ฉ๐๐ก๐ฎ ๐๐๐๐ฃ๐ฉ๐๐๐ฎ ๐๐ฃ๐ ๐ง๐๐ก๐๐๐ซ๐ ๐ฉ๐๐ ๐ฅ๐๐๐ฃ.
Many different types of pain exist, which means that effectively identifying, managing and treating the source of pain should be tailored to the individual horse in front of us.
๐๐ง๐๐๐ซ๐ฌ๐ญ๐๐ง๐๐ข๐ง๐ ๐ฉ๐๐ข๐ง ๐ข๐ง ๐จ๐ฎ๐ซ ๐ก๐จ๐ซ๐ฌ๐๐ฌ ๐๐ง๐ ๐ฉ๐จ๐ง๐ข๐๐ฌ
The experience of pain is unique to each individual horse and pony: in the way it presents, the intensity, frequency of the pain and how the horse or pony responds to treatment. In recent years, we have come a long way in better understanding the many different physical signs a horse may display to indicate that they are in pain.
Pain seldom appears alone: in can impact a multitude of different aspects in a horse or pony. A horse or pony in pain can concurrently experience changes in behaviour or temperament: this may be one of the first indicators which alerts us to our horse or pony experiencing pain. If the pain is new/acute in nature, these behavioural changes can appear totally out of character. If the pain is chronic/ongoing, the horse or pony may become withdrawn or โshut downโ in order to manage their pain. Poor performance, immune health challenges, digestive health changes and compromised fertility may all be associated with pain in our horses and ponies.
To effectively address and relieve pain in our horses and ponies, it is important to consider that pain can be multifaceted and complex. When we think of pain in our horses and ponies, we commonly think of pain which is a result of a direct physical cause. That is, pain that is associated with injury, lameness, poorly fitting tack or saddles, etc. This is what is referred to as โsomatic painโ.
Yet pain can (and often is) so much more complex than this. Which in part, helps to explain why the use of anti-inflammatories and corticosteroids doesnโt effectively resolve pain in many cases.
Different types of pain response better to different treatments due to their varying mechanisms, mediators, impact on the brain and inflammatory pathways.
To best help relieve pain for a horse, an individual, targeted approach is essential. Read on to learn more about the different types of pain our horses can experience.
๐๐จ๐๐ข๐๐๐ฉ๐ญ๐ข๐ฏ๐ ๐๐๐ข๐ง
Nociceptive pain is experienced due to ongoing activation of nociceptors (pain sensing neurons located within body organs and internal cavities).
Nociceptive pain is caused by damage to body tissues as a result of trauma and/or inflammation. When we think of pain in our horses and ponies, nociceptive pain is generally the first type of pain that comes to mind.
Nociceptive pain serves as a protective response to injury or potential harm. In cases of chronic pain however, nociceptive pain can remain ongoing, even after healing of damaged tissues is complete and there is no further sign of damage/injury.
This can be incredibly difficult in horses and ponies: an injury may be visibly healed (even on thorough imaging and diagnostic methods), yet the horse is still demonstrating signs of pain.
Nociceptive pain can be further divided into two main categories: somatic pain and visceral pain.
๐ฆ๐ผ๐บ๐ฎ๐๐ถ๐ฐ ๐ฃ๐ฎ๐ถ๐ป
Somatic pain has a direct physical cause and arises from the musculoskeletal system (muscles, bones, joints, tendons, ligaments, connective tissues) and skin.
Osteoarthritis, tendon injuries, ligament injuries, hoof abscesses, cuts and wounds are all examples of somatic pain which a horse may experience. It is what vets, body workers, farriers and other equine health care professionals are often looking for when trying to identify the source of pain.
In order to help identify the pain, lameness exams, imaging (radiographs, MRIs, PET scans, CTs, nuclear scintigraphy etc) and nerve blocks may be used.
Yet sometimes our horses still clearly demonstrate they are in pain, even when these avenues have been exhausted and there seems to be no explainable cause for their pain. So why is this?
Despite the best technology, we canโt always see structural issues, so the pain can indeed be somatic in nature, but despite our best efforts, we canโt physically see what is causing the pain. Another reason, which may be overlooked, is the pain they are experiencing may not be somatic pain (or not just somatic pain alone).
The pain our horses may be experiencing in this case is likely one (or a combination of) any of the other following types of pain.
๐ฉ๐ถ๐๐ฐ๐ฒ๐ฟ๐ฎ๐น ๐ฃ๐ฎ๐ถ๐ป
Visceral pain is pain which originates from internal organs of the body, including the stomach, intestines, liver and kidneys. It may arise due to distension, inflammation or lack of blood supply to internal organs.
Colic is a common clinical sign of visceral pain in our horses. The chronic, inflammatory nature of inflammatory bowel disease may cause visceral pain in some horses. In many cases we may not be able to visually โseeโ the source of pain using diagnostic methods, instead relying on history and assessment of clinical signs in the horse.
Identifying visceral pain can be even more challenging as it may be masked by other conditions. The discomfort a horse experiences from visceral pain can vary from mild to intense.
๐ก๐ฒ๐๐ฟ๐ผ๐ฝ๐ฎ๐๐ต๐ถ๐ฐ ๐ฃ๐ฎ๐ถ๐ป
Neuropathic pain is what we commonly think of as โnerve painโ. It is caused by nerve damage or dysfunction, resulting in dysregulation of the transmission of nerve signals into the spinal cord.
Many causes of neuropathic pain are often linked to excessive inflammation in both the peripheral and central nervous system. Inflammation however, is generally only one element of neuropathic pain.
The pathophysiology of neuropathic pain is generally complex and multifactorial, which partly explains why the use of anti-inflammatories and/or rest may only provide minimal relief in many cases.
๐๐ฒ๐ป๐๐ฟ๐ฎ๐น ๐๐ฒ๐ป๐๐ถ๐๐ถ๐๐ฎ๐๐ถ๐ผ๐ป
Central sensitisation is pain without identifiable nerve or tissue damage, which makes it challenging to diagnose.
This type of pain is thought to result from persistent neuronal dysregulation. It may play an element in cases of neuropathic pain. Some types of neck and back pain without structural pathology may be examples of central sensitisation.
๐๐ป๐ณ๐น๐ฎ๐บ๐บ๐ฎ๐๐ผ๐ฟ๐ ๐ฝ๐ฎ๐ถ๐ป
Although somatic pain can definitely be a type of inflammatory pain, immune responses in our horses can also result in inflammatory pain. This may arise in cases of infection.
๐ฅ๐ฒ๐ณ๐ฒ๐ฟ๐ฟ๐ฒ๐ฑ ๐ฝ๐ฎ๐ถ๐ป
Referred pain is pain felt in different location from actual source. Again, this can be challenging to diagnose. For example a horse experiencing problems with its temporomandibular joint (TMJ) or teeth may have referred pain in the neck- with the neck appearing as if it is the source of pain itself.
๐ฃ๐๐๐ฐ๐ต๐ผ๐ด๐ฒ๐ป๐ถ๐ฐ ๐ฃ๐ฎ๐ถ๐ป
Psychogenic pain is physical pain that is caused, increased or prolonged by emotional, mental or behavioural factors, without evidence of physical injury or illness.
Psychogenic pain may not yet be commonly recognised as a clinical diagnosis in horses, but as we understand more about the role of stress, social isolation, anxiety, lack of freedom of movement, boredom and frustration in the equine- the role of psychogenic pain should not be overlooked.
From a clinical perspective, monitoring and/or observing signs such as increased reactivity, heart rate and/or respiratory rate stereotypies (wind sucking, cribbing, weaving, box/stall walking, paddock walking) may all be indicative of psychogenic pain.
๐๐ฒ๐ ๐๐ฎ๐ธ๐ฒ๐ฎ๐๐ฎ๐๐
In any case of a horse or pony experiencing pain, taking a thorough case history and conducting a comprehensive, holistic assessment gives us the best chance in understanding the potential causes and contributing factors to their pain.
It is important to note, that in many cases, whilst clinical signs can be useful to help understand pain better in our horses and ponies, they are often non-specific.
The treatment approach we take for specific types of pain should be different if we want the pain relief to be truly effective for our horses and ponies and resolve the source of pain.
