Equine pain management still hinges on better assessment: full analysis

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Managing pain in equine patients is still as much about recognition as drug choice. Recent Vet Times coverage on assessment and analgesic strategies argues that postoperative pain should be presumed in horses and addressed proactively, with clinicians relying on repeated reassessment to tailor therapy before, during, and after surgery. The reporting highlights a multimodal approach rather than a single preferred drug class, reflecting how equine pain medicine has evolved into balancing efficacy, safety, sedation, gastrointestinal function, and practicality. (vettimes.com)

That emphasis comes against a backdrop of longstanding limitations in equine analgesia. Compared with small animal practice, horses have historically had fewer straightforward analgesic options and more concern that treatment could mask deterioration, especially in cases involving colic or major orthopedic disease. Earlier Vet Times reporting described the same tension: clinicians want to control pain, but not at the expense of obscuring a surgical abdomen, worsening ileus, or increasing recovery risk. (vettimes.com)

The core strategies remain familiar. NSAIDs continue to anchor many protocols, while opioids, local anesthetics, alpha-2 agonists, ketamine, and lidocaine are used as adjuncts or in combinations designed to produce additive or synergistic effects. Vet Times notes that pre-emptive analgesia is encouraged to reduce central sensitization, lidocaine infusions are commonly used after gastrointestinal surgery because of their perceived value in reducing postoperative ileus, and ketamine CRIs are used for antihyperalgesic effects. Regional techniques also remain important, especially epidural analgesia for caudal lesions or postoperative pain management, though careful technique is needed to avoid complications such as ataxia. (vettimes.com)

What has become clearer in the broader literature is that assessment may be the weakest link. A 2025 editorial in Frontiers in Pain Research said equine pain research still lags behind small animal medicine in some areas, and that horses’ pain expressions are subtle and multifactorial, contributing to underrecognition and undertreatment. The authors also pointed to inconsistent real-world use of equine pain scales, even though several tools are already available. Related research continues to refine those tools, including 2024 work on improving the Horse Grimace Scale and recent studies examining how facial expression and posture change with orthopedic pain intensity. (cdpm.vetmed.ufl.edu)

The evidence base for some everyday analgesic decisions also remains thinner than many clinicians would like. In a systematic review published in late 2023, investigators found only 10 eligible studies on NSAID therapy for horses with abdominal pain, with just one using a validated pain score and an overall high risk of bias across the literature. Their conclusion was cautious: current evidence is too sparse to confidently say whether one NSAID provides better analgesia than another in that setting. That finding reinforces why many equine protocols still depend heavily on clinician judgment, patient response, and multimodal planning rather than rigid hierarchies of drug choice. (pubmed.ncbi.nlm.nih.gov)

Industry and expert commentary increasingly centers on making pain scoring more usable in practice, not just more sophisticated on paper. Educational programming for equine practitioners in 2024 and 2026 has highlighted perioperative pain management and the role of pain scores in everyday decision-making, suggesting the field is trying to close the gap between published scales and bedside use. That aligns with the Vet Times framing that subtle behavioral changes, repeated observation, and familiarity with normal versus abnormal behavior are central to good analgesic care. (aaep.org)

Why it matters: For veterinary teams, this is less a story about a new drug than a reminder that equine pain management is becoming more structured, but not necessarily simpler. Multimodal analgesia is standard thinking, yet every major option comes with caveats: NSAIDs can affect the gastrointestinal tract and kidneys, alpha-2 agonists can contribute to ileus and cardiorespiratory effects, opioids may be limited by regulation or adverse-effect concerns, and infusions or epidurals require monitoring, equipment, and experience. In practice, that means protocols work best when pain assessment is treated as a repeated clinical process, not a one-time score, and when teams are prepared to modify plans quickly as the horse’s status changes. (vettimes.com)

What to watch: The next phase is likely to focus on better validation and adoption of pain scales, more objective tools for detecting subtle pain, and stronger comparative evidence for specific analgesic protocols, especially in postoperative, colic, and chronic musculoskeletal cases. (cdpm.vetmed.ufl.edu)