I read a very interesting study published earlier this year that validates what many horse people have already been seeing and experiencing. Through this study, researchers have developed a tool to aid in the assessment of musculoskeletal pain in horses. You can find the full research article cited and linked at the bottom of this post.
The study presents the development and validation of a new equine musculoskeletal pain scale. The scale uses both physical signs (like posture and gait) and behavioral cues (such as changes in demeanor) to provide a reliable pain assessment tool to help veterinarians, horse owners, and equine professionals more accurately assess pain in horses. This tool could improve pain management and treatment outcomes in horses, especially for musculoskeletal conditions that can be difficult to diagnose.
The study addresses the challenge of reliably assessing musculoskeletal pain in horses, a problem that has hindered proper diagnosis and treatment. Current methods lack consistency and can miss key signs of pain. The equine musculoskeletal pain scale developed in this research aims to fill that gap by offering a validated, systematic tool based on observable physical and behavioral indicators.
My hope is that a scale like this is adopted by veterinarians to allow them to make more accurate clinical decisions, leading to better pain management for horses. Veterinarians often struggle to assess musculoskeletal pain in horses due to inconsistent methods and the difficulty of identifying pain indicators.
In addition, many studies have shown that there is a discrepancy between observable pain in horses and what most owners are able to perceive in their horse. Education and tools in this area will aid horse owners to recognize signs of pain early, and seek appropriate interventions.
In the study, the Musculoskeletal Pain Scale, or MPS, "showed good repeatability between expert and lay scorers, significant correlation with lameness at the walk and trot, and good predictive validity for longitudinal health outcomes, confirming its ability to identify horses with orthopaedic health problems."
While it is never a replacement for veterinary diagnosis and treatment, I strongly believe that having regular visits from a qualified equine bodyworker is an effective way to monitor your horse for early and subtle signs of pain. An educated bodyworker putting their hands on your horse regularly can pick up on any adverse adaptations long before they turn into major pain, lamenesses, or affect performance under saddle. Noticing these changes early and notifying you as the horse’s guardian aids you in your decisions regarding anything from training methods, turnout, hoof balance, nutrition, tack fit, to veterinary care. All of these aspects of care have an effect on what is showing up in the body. Not only is bodywork effective to prevent pain and discomfort, but it is an important piece of your horse's care team to monitor their musculoskeletal health. It is no different than your farrier regularly caring for your horse's hooves, notifying you of changes and referring veterinary treatment when needed.
Other interesting takeaways from the research:
"Musculoskeletal disease is the leading cause of chronic pain in horses and humans alike. In equine veterinary practice, lameness due to musculoskeletal pain ranks as the most prevalent diagnosis. Already, in 4- to 5-year-old riding horses, 24% demonstrated moderate to severe orthopaedic clinical findings, emphasizing the widespread nature of the problem. The prevalence further increases in older horses, with 51% of horses above 15 years and 77% of horses aged 30 years and older exhibiting lameness, which is strongly associated with pain experienced at rest."
"Despite their high prevalence, musculoskeletal diseases are frequently overlooked as a source of suffering and, as a result, receive inadequate treatment. Indeed, owners reported lameness in only 16% of horses compared with the 77% diagnosed by veterinarians in the same cohort. Similarly, in two other groups of horses in training that were perceived to be sound by their owners, 72.5% and 74% showed movement asymmetry during objective lameness evaluation. The owners’ low perception of musculoskeletal pain compared with the expert diagnoses is concerning from both a veterinary and welfare perspective. It further compounds the undertreatment of pain also observed in older humans that is associated with the erroneous but widespread societal belief that pain is a natural part of ageing and inevitable in later life."
"Due to the subjective nature of pain, gold standard pain assessment tools in human medicine rely on self-reporting, as direct measurement of individual experiences is not feasible. For patients unable to communicate in ways easily understood by their caregivers, such as non-verbal human patients and animals, pain assessment depends on physiological and behavioural indicators. However, physiologic indicators, including changes in heart and respiratory rate, lack the sensitivity and specificity needed for reliable pain detection and discrimination from other sources of distress."
"As some behavioural changes associated with chronic pain may develop gradually and be subtle, making them most easily detected by someone familiar with the animal and its behaviour before and after the onset of pain, the inclusion of caretaker assessments can add important cues to facilitate identification of equine pain. Regular pain assessment by caretakers is also essential to optimize treatment, as chronic musculoskeletal conditions typically require prolonged and often life-long palliative treatment and therapy adjustments to address acute flares and fluctuations in pain intensity while minimizing side effects."
"Pain is a complex, uniquely individual, unpleasant experience associated with actual or potential tissue damage, encompassing both sensory (intensity) and affective (unpleasantness) components. The affective dimension of pain is associated with behavioural changes aimed at avoiding pain and minimizing injury. While acute pain is a protective response to noxious stimuli, chronic pain persists beyond the expected healing time and may be either a symptom of chronic peripheral disease, maladaptive nervous system dysfunction, or both."
"As symmetrical loading of the limbs provides the greatest biomechanical stability and hence requires the least corrective actions and energy to maintain balance, sound horses exhibit a symmetrical weight distribution, with approximately 60% of the weight borne by the forelimbs and 40%, by the hindlimbs. Conversely, horses afflicted with orthopaedic conditions may attempt to alleviate pain by shifting the weight away from the affected limb, effectively altering their centre of gravity. Weight-bearing and stance asymmetry may therefore signal pain relieved by adopting this posture. Similarly, an elevated neck posture has been identified as a potential indicator of underlying back disorders in horses. Therefore, the MPS includes head–neck posture, limb posture, weight-bearing, and weight shifting as separate items to reflect the postural adaptations commonly observed in response to orthopaedic pain."