There’s no doubt that seeing our horses in pain is distressing. Our first instinct is to do whatever we can to alleviate the pain, however we can. But it’s also important to understand that pain serves a purpose: it’s a signal that tells the horse (and us) when something is wrong. 

Some of the most common painful experiences for horses include colic, degenerative joint disease, laminitis, gastric ulcers, and hoof problems. As owners, it’s our responsibility to not only recognize pain, but also manage it when necessary. 

Types of Pain in Horses

There are two types of pain: adaptive and maladaptive. Adaptive pain serves a purpose, letting the horse know to protect an injury in order to promote healing. 

Maladaptive pain, on the other hand, is dysfunctional, often caused by chronic conditions or, in some cases, trauma from surgery. Maladaptive pain does not protect or support healing, but leads to a vicious cycle in which the horse never fully heals. 

Our goal should be to eliminate maladaptive pain as best we can while allowing adaptive pain to serve its purpose. 

Classifying Pain in Horses

Veterinarians classify pain by specific factors, including: 

  • Duration 
  • Anatomic location
  • Quality such as dull, sharp, burning, stabbing, throbbing, persistent, etc. 
  • Intensity such as mild, moderate, severe, excruciating, crippling

More recently,  three broad categories of pain have also been identified:

  1. Nociceptive pain is caused by damage to bodily tissue. This usually occurs as the result of an external injury and leads to a behavioral response involving a motor withdrawal reflex or other, more complex protective behaviors. Nociceptive pain is not chronic or permanent. 

  2. Inflammatory pain is produced by the activation of nerve-ending cells which then secrete inflammatory molecules. This is a type of adaptive pain that leads to a decrease in movement until the tissue heals. However, inflammatory pain can also become maladaptive if it’s excessive. In this case, it needs to be managed. 

  3. Neuropathic pain comes from dysfunction or damage to the peripheral or central nervous system, usually secondary to trauma or chronic inflammatory disease. Neuropathic pain does not serve to protect or repair injured tissue; therefore it is also considered maladaptive and needs to be controlled. Examples of neuropathic pain include headshaking, arthritis, laminitis, as well as surgical trauma. 

Scales for Assessing Pain

In the past, veterinarians were limited to using measurements such as heart rate, respiratory rate, and cortisol levels to assess pain, but today, pain scales are used. These types of scales better assess the level of pain a horse may be experiencing.

  • Obel Laminitis Pain Scale

This scale is commonly used for horses diagnosed with laminitis, classifying lameness severity from grade I to IV. The Obel scale also includes behaviors such as weight shifting, resistance to picking up feet, and physical disability. 

  • AAEP Lameness Grading Scale

The American Association of Equine Practitioners (AAEP) has a scale which is commonly used by many veterinarians. This scale ranges from 0-5,  with 0 being no lameness apparent and 5 being a complete inability to bear weight or a complete inability to move.

  • Horse Grimace Scale

As the name implies, this scale uses facial expressions to evaluate pain. The grimace scale includes detailed descriptions and photographs to illustrate different expressions associated with varying levels of discomfort in horses. For example, low or asymmetrical ear positioning, dilated nostrils, and tension in any of the facial muscles are commonly associated with pain.

Signs and Symptoms of Pain in Horses

Of course, you don’t have to be a veterinarian to recognize signs of pain in horses. Many experienced owners can detect even subtle changes in their horse’s demeanor or movement. However, horses are also known for being stoic, showing few signs of pain in some circumstances. 

With that said, some general signs that a horse will show when experiencing pain include the following:

  • Pawing
  • Stamping
  • Repeated tail-swishing 
  • Circling in stall
  • Repeated flaring of nostrils 
  • Repetitive behaviors such as rubbing or pacing
  • Laying down and getting back up frequently
  • Rocking back and forth on limbs
  • Grunting
  • Grimacing
  • Flattened ears
  • Lowered head position
  • Altered eating or drinking

Some signs of abdominal pain (i.e. due to colic or ulcers) include:

  • Pawing
  • Flank watching or biting
  • Teeth grinding
  • Kicking at abdomen
  • Rolling
  • Grunting
  • Thrashing

Pharmaceutical Pain Management Options

Managing chronic or maladaptive pain is crucial for improving your horse’s quality of life. Depending on the type and location of the pain, there are a variety of pharmaceutical drugs, as well as natural or nutritional treatments, available. 

For horse owners, there are two main categories of drugs available by veterinary prescription:

  • Steroidal and Non-Steroidal Anti-Inflammatories
  • Opioids


Corticosteroids are often given for immune-related diseases such as equine asthma or to decrease inflammation and fever with life-threatening inflammatory diseases. They can also be injected into the joint for osteoarthritis or used topically for conditions such as uveitis (moon blindness). However, corticosteroids are not safe to use long-term in most cases. 

Non-Steroidal Anti-Inflammatories

Non-steroidal anti-inflammatory (NSAID) drugs, on the other hand, are commonly prescribed for pain management for anything from osteoarthritis to colic. There are two general types of NSAIDs to be aware of: COX-1 and COX-2 selective NSAIDs. 

To understand how NSAIDs work, it’s helpful to know what COX enzymes do. These enzymes make immune compounds called prostaglandins at the area of tissue damage or infection and help with healing processes like inflammation, blood flow, and blood clotting. 

When COX enzymes are blocked by NSAIDs, these processes are reduced, and the result is relief from pain. The problem is that NSAIDs, especially those that are COX-1 selective, should not be used long-term because they can cause damage to the gastrointestinal tract. 

NSAIDs are often prescribed for inflammatory conditions such as laminitis, osteoarthritis, and surgical trauma. The most commonly prescribed COX-1 selective NSAIDs include: 

  • Phenylbutazone (Bute)
  • Flunixin meglumine (Banamine)
  • Diclofenac sodium (Surpass)
  • Ketoprofen (Ketofen)

COX-2 selective NSAIDs work similarly to COX-1 selective NSAIDs but don’t cause the same damage to the gastrointestinal tract. Though they can be used safely over a longer period of time, research shows that even COX-2 selective NSAIDs should not be used continuously for long periods of time. 

Some examples of COX-2 selective NSAIDs include firocoxib and meloxicam. 


Opioids have been used for many years in veterinary medicine. However, this type of drug comes with the risk of causing decreased gastrointestinal motility if used long term. Butorphanol is the most commonly used opioid for horses, but others include the fentanyl transdermal patch and tramadol, which is sometimes used for horses with chronic laminitis. 

Long Term Pain Management in Horses 

Aside from using veterinarian-prescribed drugs, there are many over-the-counter nutraceuticals that can be helpful in alleviating pain in horses as well. Here are a few:

  • MSM

Methylsulfonylmethane, or MSM, is commonly used to alleviate joint pain in horses. MSM contains sulfur and has been well studied as a treatment for arthritis and sore muscles.

  • Devil’s Claw

Devil’s claw is a plant that is known for its healing effects, especially as an anti-inflammatory and analgesic (pain reliever). Many people use it in place of Bute because studies show that, unlike NSAIDs, devil’s claw is safe for long-term use and doesn’t negatively impact the gastrointestinal system.

  • Curcumin/Turmeric

Similar to devil’s claw, turmeric also has anti-inflammatory properties. Curcumin is the active ingredient in the turmeric plant and is often extracted to use in supplements. Curcumin is commonly used for horses with laminitis, osteoarthritis, and other inflammatory health conditions. 

  • Probiotics 

While many people may not think of probiotics as pain-relieving, studies show that they can be effective in managing inflammation associated with some conditions. 

According to studies in people and animals, probiotics such as Fullbucket’s EQ Probiotic Pellets Extra Strength may help to slow progression and alleviate symptoms of inflammation without causing adverse side effects. 

Many studies show that probiotics can help to adjust the balance of pro-inflammatory and anti-inflammatory cytokines and also increase antibodies that help fight infection. Also, due to probiotics’ impact on opioid receptors in the body, it appears they may also have pain-reducing effects. 

Dealing with a horse in pain isn’t enjoyable by any means, but understanding the types of pain horses experience, as well as the options when it comes to managing severe or chronic pain, can help to make a difficult situation a little easier. Always discuss any concerns with your veterinarian, especially if you feel like your horse’s current pain management program isn’t as effective as it needs to be. 

Try the #1 veterinarian-formulated and approved probiotic today! Designed for your horse, no matter their condition.← 

Read More:

Probiotics and Inflammatory Pain: A Literature Review Study

Photo by Jez Timms on Unsplash

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