Is This Horse In Pain?

My winter of learning was an intense one! I am so excited to announce that I am now certified to perform veterinary spinal manipulation therapy (VSMT or animal chiropractic treatments) after over 200 hours of studying, practicing, and learning from some amazing chiropractors and veterinarians. I have also spent a lot of time learning about equine dental diseases and extractions. You may think that these two different ventures don’t really go together. I would argue that it is actually all about finding different ways to provide pain relief and improve comfort for our equine companions. It is all about PAIN.

Horses are programmed by evolution to hide their pain. If they show pain or illness, then they are most likely to be the next one on the menu of the predators in the area. As their human companions we have learned to decipher some of their subtle hints. Almost every horse person will spring into action at the first sign of a roll, belly kick, and forlorn gaze at the abdomen. We speak ‘colic’ very well indeed.

But what about pain signs that aren’t as easy to interpret? The horse that is no longer interested in the second bite of their carrot? The horse that pins its ears when the saddle is put on? Do we always notice these subtle signs? And what can we interpret from them? Pain and communication is an exciting area of equine behavior research. Recently an ethogram was presented for horses to evaluate stress and pain in riding programs. An ethogram is a catalogue of specific behaviors in a species. I might just be a behavior nerd but this is REALLY EXCITING! We can’t ask a horse if it is painful but we can learn to understand their subtle body language. Dr. Sue Dyson has put together some short videos explaining the work, I highly recommend watching them.

https://thehorse.com/110436/an-ethogram-for-ridden-horse-facial-expressions-of-pain/

With this research progressing we may soon be able to stop guessing at the pain level in our patients. Until then we sometimes have to use our knowledge of human medicine and apply that to horses. This isn’t a perfect system but with so much similarity in our biology and nerve pathways it seems safe to assume that the sensations that we find painful also affect our horses. For example – dental pain. Ask anyone who has suffered a tooth root abscess, a root canal, or even just had their braces tightened – dental pain is awful! It often isn’t even a sharp, specific pain, it tends to be a dull, throbbing, headache, moaning, feel sorry for yourself kind of pain. So how can horses show us this? In my experience, they don’t. They keep eating, keep working, and try their best to hide their discomfort. Sometimes there are signs: they are depressed, or the tell-tale sign for incisor pain – they happily take a bit of a carrot but refuse to go back for a second bite, the first one cost them too dearly. One of the really exciting skills that I have developed this winter is the standing procedure to extract incisors. There is a disease process called Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) when the horse’s body starts to attack and resorb the incisor teeth (the front teeth used for grabbing grass and treats). We don’t fully understand this disease and at this time the best treatment is taking the teeth out. They can be reactive, infected, and disgusting. The first time I did this procedure each tooth that came out was shortly followed by a big buildup of pus that was sitting at the tooth route. That’s gross, I know, the people watching had to walk away. This poor little pony had been walking around with that in his head and he didn’t tell anyone! I heard from the owners shortly after the procedure that they couldn’t believe it, they had their pony back! They had thought his quiet attitude and reduced interest in feed was simply because he was getting old. As soon as those diseased teeth were out he was a new pony! I get this response frequently after taking out diseased eyes as well, and that is why it is one of my favourite procedures and I am so happy that I took the extra time to learn the technique. I can take away significant pain and give people back their happy horses!

What about the pain that isn’t quite so intense or local? The overall body discomfort that makes us as humans move a little more slowly first thing in the morning or the day after a particularly difficult workout? Is that pain? We usually give it a different name: discomfort, aching, stiffness, creaky, feeling ‘old’. Do horses experience that kind of pain? I certainly think they do. Equine athletes, pleasure horses, retired horses, whatever their job in life, they are all individuals with their own past injuries, bad posture, hard workouts, and creaky joints. As humans and caretakers we seek relief for this kind of pain – massage therapy, chiropractic treatment, acupuncture, physiotherapy, pain medication, and the other million and one ways humans have developed to decrease pain. One of the things that I absolutely love about animal chiropractic treatments is how much the animals seem to love it. They don’t have any of the internal debate going on in their brain about whether or not they “believe in chiropractic”, they either feel better or they don’t. A lot of the time they feel better and it is so exciting to have horses that like me again! The changes in their gait, their stance, and their overall comfort can be dramatic. My practice case during the course was a lovely 27 year old pony with chronic laminitis. His laminitis is under control but his overall body pain from the way he had been carrying himself during episodes of foot pain meant that we had to keep him on low dose NSAIDs to control his discomfort. Through the months of chiropractic treatments we noticed a difference in his overall body comfort coming out of the stall each morning and we were able to take him off of pain drugs completely. That is really exciting to me!! Medications have their time and place and I will never fully stop thinking like a vet but it is really exciting to be able to approach some of these issues in a different way, or to have more to offer when the medications aren’t enough.

Ultimately a huge part of our job as veterinarians is preventing and treating pain or discomfort. I am so excited that as a profession we are continuously seeking new ways to identify and treat this pain in our horses. The next step will be to take care of all of us old, stiff horse people that have bad backs from years of pushing wheelbarrows and tossing hay bales!

Resources:

https://thehorse.com/110436/an-ethogram-for-ridden-horse-facial-expressions-of-pain/

https://thehorse.com/111913/getting-to-know-eotrh/

https://horse-canada.com/magazine_articles/equine-chiropractics-coming-of-age/

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