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Pain - recognising and treating

Recognising pain in your horse

Pain recognition in horses can be very difficult; this is because many horses naturally try to hide their vulnerability to predators. Similarly to humans, individual horses have variations in how they express pain, and often you, as their owners who are very familiar with their individual normal behaviour, are key in recognising some of the more subtle signs of pain.

Horses demonstrate numerous and varying signs of pain. These are dependent on factors such as the individual animal, the environment and circumstances, the location of the pain and the severity of the pain. Some of the ‘general signs’ of pain may seem contradictory but reflect the variation in how individual horses show pain

General signs of pain in horses:

• Pawing
• Stamping
• Tail swishing (with no insects)
• Circling in the stable
• Repetitive behaviours such as pacing, box walking etc or change in normal behaviour
• Repetitively getting up and lying down
• Grunting
• Unsettled appearance
• Aggression
• Self mutilation – biting at itself
• Lowered head
• Lack of normal human interaction
• Spending more time at the back of the stable
• Separating themselves from the herd
• Loss of appetite
• ‘Pain face’ (see below)

Signs of pain in horses relating to specific areas:

Signs of eye pain:

• Holding eye closed
• Swollen eye
• Watering eye
• Discharge from eye
• Frequent blinking
• Sensitivity to light
• Rubbing eye
• ‘Pain face’ (see below)

Signs of pain in a particular location:

• Stiffening up when touched
• Muscle twitching when touched
• An apparently exaggerated response to touching
• A violent response to touching: biting, striking, kicking
• Swelling and heat
• ‘Pain face’ (see below)

Signs of limb pain:

• Shifting weight frequently
• Rocking on limbs
• Pointing one limb
• Stamping
• Biting at limb
• Reluctance to movement
• Not fully weight bearing on one limb
• Reluctance to pick up a limb and weight bear on a painful limb
• Lying down more frequently
• ‘Pain face’ (see below)

Signs of abdominal pain:

• Pawing
• Stretching out
• Posturing to urinate frequently
• Turning to look at flanks
• Biting flanks
• Grinding teeth
• Kicking towards belly with a hind foot
• Lying down and getting up frequently
• Rolling on the ground
• Sweating
• Grunting
• Rolling uncontrollably and injuring themselves or damaging their environment
• ‘Pain face’ (see below)

Pain face:


  • The ears of horses in pain stop pointing forward and gradually become lowered with the opening of the ears out or slightly back.
  • The ears are often asymmetric in the direction they face in horses with pain.


  • The top eyelid becomes more ‘angled’. In some horses, the white of the eye (sclera) may be visible at the top of the eye.
  • The stare may become withdrawn and intense over face

Lower face

  • The nostrils dilate and change form appearing elongated to become more square in shape
  • The muscles in the lips and chin become more tense
  • The muscles on the side of the head become more tense

If you recognise these signs in your horse and you are worried about your horse being in pain, please contact us at BELL EQUINE on 01622 813700

As in humans, treating pain in horses is essential. Untreated pain in horses can compromise their quality of life, mental state and even their physiology. Appropriate doses and timings of painkillers often mean that lower overall levels of painkillers are necessary. However, all medications have some side-effects so we have to balance making sure horses are as comfortable as possible with the side-effects of the painkillers.

Sometimes short courses of painkillers are used; however, other horses may need longer courses of painkillers. Once a diagnosis has been reached, some horses with chronic painful conditions (such as osteoarthritis) may be maintained on low levels of painkillers indefinitely to optimise their quality of life. In these horses, regular health checks must be performed (at least every 6 to 12 months, or in some cases more frequently) before more medication can be prescribed or dispensed. This is to ensure they are on the correct dose and that the painkillers are not adversely affecting the horse.


Nonsteroidal anti-inflammatory drugs:

The most commonly used painkillers in horses are a group of drugs called ‘nonsteroidal anti-inflammatory drugs’ - NSAIDS. These work in the same way as ‘paracetamol’ and ‘ibruprofen’ that people take, but they are specifically designed medications for horses.

For more on the most common NSAIDS we use, please see the link HERE.

Occasionally, vets at Bell Equine will choose to use other oral painkillers in your horse or may even give you injectable painkillers to give to your horse. If you have any questions about pain management in your horse, please contact us at Bell Equine.