Researchers have recently shown that knowing horses’ pain levels during hospitalization would be beneficial for horses and veterinary staff alike, but putting these efforts into practice can be challenging.

A perceived lack of useful pain assessment tools, variations in pain scoring among different staff members, and the difficulties of reading the unique, subtle cues specific to individual horses might prevent veterinary hospitals from implementing systematic pain assessments in their equine patients, said Olivia Curry, PhD candidate at the Royal (Dick) School of Veterinary Studies at the University of Edinburgh, in Scotland.

Even so, staff are eager and willing to work toward that goal—which she said would ultimately lead to better pain management, more informed treatment decisions, happier horses, and safer caretakers.

“Veterinary staff recognize the importance of pain assessment but face challenges due to limitations in current methods, training, and interpretation of horse behavior,” said Curry during her presentation at the 2024 Conference of the International Society for Equitation Science, held March 14-16 in Cambridge, New Zealand. “Nevertheless, there really is a strong desire for improvement, including better tools for training and standardized protocols within the hospital.”

Although there are multiple methods, tools, and a smartphone app designed to assess pain in horses, there’s no evidence that equine veterinary hospitals use them, she said.

To assess how hospital staff members view systematic pain assessment, Curry and her fellow researchers carried out open-ended interviews with nine staff members—including veterinary surgeons and nurses—at the Dick Vet Equine Hospital. They asked the interviewees to openly talk about their experiences, thoughts, and issues regarding pain assessment in their patients.

Comments during this discussion included: “I think we could do a lot better” and “In an ideal world, we would pain-score every horse with a painful condition.” In reality that doesn’t happen, however, Curry said.

After thoroughly analyzing the responses they received, Curry and her colleagues identified nine themes of concern that fell into three categories:

1. How to assess pain.
   • Existing methods and tools have limited use in a hospital, being highly subjective and time-consuming.
   • Pain assessment is nonetheless important and needs to be done more often.
   • Staff are motivated and want to do better, so it’s important to optimize the approach.
2. Effects of the person doing the pain observations.
   • Education, training, and general experience with horses can influence results.
   • People’s personal experiences with pain and any inaccurate assumptions that horses are like people (anthropomorphism) can sway observations.
   • Results can vary significantly from one staff member to another as well as between hospital staff and horse owners.
3. The horse itself.
   • Individual horses and even breeds can express pain in different ways.
   • The stress of traveling and change of environment in a hospital setting can alter the way a horse shows pain.
   • Subtle signs of pain, such as standing at the back of the stall, can get overlooked.

Opportunities for Future Research

Although the researchers focused on a single equine hospital, their findings nonetheless point to themes that—if confirmed through additional, larger studies—could merit further research, Curry said. And that’s important because identifying pain and managing it appropriately plays a critical role in keeping hospitalization safe and ethical for equids and their handlers, she added.

“Accurate pain assessment is vital in equine veterinary medicine and welfare due to its potential to identify significant distress and suffering,” Curry explained. “Painful experiences can adversely affect (horses) physical and psychological well-being, as well as impact physiological functions, social interactions, and normal behaviors. Pain-induced behavioral changes such as aggression, fear, and withdrawal can compromise the safety of people and the horse-human relationship.”

She continued, noting that future research could focus on training for hospital staff, practicality of implementation, expansion of use, and larger-scale studies.