Pain control in horses: what do we really know?
Authors: Sanchez L C, Robertson S A
Journal: Equine veterinary journal
Summary
Sanchez and Robertson's 2014 review highlights a critical gap in equine practice: pain assessment and management remain inconsistent across the profession, combining subjective observation with pharmacological intervention rather than evidence-based protocols. Whilst obvious pain behaviours such as rolling, kicking and lameness are readily recognised, subtle indicators—including altered facial expression, postural changes and modified responses to handling—are frequently overlooked, potentially delaying treatment of significant discomfort. The authors survey the landscape of available analgesics, from first-line NSAIDs (phenylbutazone, flunixin meglumine, firocoxib) through opioids and α₂-agonists, to multimodal infusion protocols combining lidocaine, ketamine and butorphanol for severe pain in hospitalised horses, alongside emerging use of neuropathic agents like gabapentin for conditions such as laminitis. The practical takeaway for equine professionals is that analgesia should be individualised according to pain severity and chronicity, with consideration given to delivery route (intra-articular, epidural), special populations (foals), and mitigation strategies for adverse drug effects. This systematic approach demands sharper attention to pain recognition across all presentations—not merely the dramatic cases—and collaborative decision-making between farriers, veterinarians and other handlers to optimise welfare and recovery outcomes.
Read the full abstract on PubMed
Practical Takeaways
- •Assess pain in horses using both obvious signs (lameness, rolling, flank watching) and subtle indicators (facial expression, behavior changes, stance) to ensure appropriate treatment
- •Use multimodal analgesia combining NSAIDs, opioids, and/or α2-agonists tailored to pain severity and chronicity rather than single-agent therapy
- •Consider specialized delivery methods (intra-articular, epidural) and neuropathic agents (gabapentin) for specific conditions and hospitalized cases, with adjusted protocols for foals
Key Findings
- •NSAIDs (phenylbutazone, flunixin meglumine, firocoxib), opioids (butorphanol, morphine, buprenorphine), and α2-adrenergic agonists (xylazine, detomidine, romifidine, medetomidine) are the most commonly used analgesic agents in horses
- •Multimodal therapy using constant-rate infusions of lidocaine, ketamine, and/or butorphanol has gained popularity for severe pain management in hospitalized horses
- •Pain recognition includes both overt behaviors (rolling, kicking, lameness) and subtle signs (facial expression changes, head position, response to palpation)
- •Gabapentin and other neuropathic pain drugs are increasingly used for conditions such as laminitis, with special consideration needed for intra-articular, epidural delivery, and foal-specific protocols