I’m going to pose a lot of questions here, and likely not offer a whole lot of answers. I don’t think I’ve heard this topic discussed much in public, and I get the feeling that we don’t really have a way of addressing it in our equine culture. But some of us are likely living with this question right now, and if we’re fortunate enough not to be faced with it ourselves, we may know someone who is.

The profound quandary I speak of is the horse in chronic, daily, unmitigated pain. I think we all agree that horses are “sentient” beings, meaning that they are conscious, aware and capable of sensation. Basically that means in part that horses can feel pain. I believe a majority of (but not all) horse owners/horsemen agree on this. If we agree that horses can feel pain, then it would logically follow that the possibility exists for a horse to feel consistent, chronic pain. I suppose the question posed here is what, if anything, can and/or should we do about this?

Assessing pain in horses is a tricky thing, mainly because horses can’t talk and put their degree of pain on a numerical scale (0-10) like humans can. Different horses display pain in different ways. Some horses are stoic and others are very dramatic in their expression of pain. Does that mean the stoic horse is in less pain than the dramatic horse? Different people observe and assess equine pain in different ways. This is a subjective judgment, and two people can look at the same horse and come up with completely different numbers on the pain scale. Veterinarians do not have a standardized methodology to assess and grade pain in horses. I don’t know that there is a sure way to diagnose chronic pain (especially full-body pain) in horses. In my experience, few horses are ever diagnosed with chronic pain that does not show as a distinct clinical lameness. But I know I’ve seen it.

We assume that horses are born perfect. We assume horses are born sound. But studies show that a surprising percentage of foals are born with rib cage injuries severe enough to be seen on x-ray. Horses are born with crooked legs, why not crooked spines? We assume that all horses have perfect genetics, though they may have the same grandfather on the top and bottom of their papers. We assume that the huge bones and muscles of the body are impervious to injury because the diagnostics for those areas aren’t readily available. Again, there are more questions here than there are answers.

Over the winter, I started running some numbers. I’ve had the opportunity to follow up with some horses I’ve seen at clinics over the years, and hear what had happened after they went home. What I found out is that a surprising number of horses I see at clinics appear to have as-yet undetected or undiagnosed clinical veterinary issues. These issues I’ve seen (some of which I’d been able to identify and some not) included OCD lesions, arthritis, EPM, Lyme disease, various clinical lamenesses, broken bones, gastric ulcers, clinical footsoreness and various neurological disorders. I estimate that at least 10% of the horses I see at clinics have clinical veterinary issues that may or may not have something to do with why the horse is at the clinic or what he’s capable of doing while he’s there.

I estimate that another 20%-50% of the horses I see have less severe, “sub-clinical” physical disorders like chiropractic issues (stuck joints, lack of movement), soft tissue issues (tightness, soreness), saddle fit issues and foot issues. Sometimes these issues manifest in an easily visible clinical head-bobbing lameness, but more often these issues show in the horse as more subtle assymetries of gait, muscling or posture.

There is another quandary here, for the equine professional. Only veterinarians are licensed and legally entitled to make a diagnosis or treatment recommendation. This puts the equine professional and the horse owner themselves in a sticky spot, because we are not always able to obtain all the information we need from our veterinarian. Sometimes it takes a team of various professionals and practitioners working together to figure out what’s going on and what to do about it. But keep in mind that when we ask anyone but a veterinarian for a diagnosis or treatment recommendation, we may be asking them to break the law.

There are horrible questions here, and the questions beget more questions, and we as a culture don’t have a mechanism to ask and then answer the questions. But here are my questions:

• What would cause us to question if our horse is in chronic pain?
• Once we have the question, how would we go about diagnosing the degree of pain?
• Once we know a horse is in chronic pain (if that can even be done), how long is it ethically acceptable for, with our knowledge, him to be in chronic pain?
• If the horse is in chronic pain, is it fixable? How long is okay for him to be in pain while we try to fix it?
• What is the solution for a horse with unfixable chronic pain? Let the horse live in pain? Euthanasia? Life-long painkillers?
• And then there’s the “money question”. How much is each of us willing/able to spend to answer the above questions?

Like I said, I’ve just got questions on this one, not answers.