The Modern Equine Vet
December 2023
Vol 13 Issue 12 2023
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Pain

Is It Pain or Behavior Issues?

By Landon Gray

Recognizing and understanding behavior will help in diagnosing and managing pain in equids, according to information presented at the 2023 BEVA Annual Congress, in Liverpool, England.

“Is it pain or behavior? I think very often it is both,” explained Gemma Pearson, BVMS, Cert, AVP (EM), MScR, CCAB, PhD, MRCVS, the director of equine behavior at The Horse Trust, in Buckinghamshire, England.

She defined behavior as the motor output of sensory input that is modulated by other factors, including current mood and emotional state. Studies in other species have shown that pain contributes to anywhere from 28% to 82% of unwanted behaviors.

Think about your emotional state when you hurt yourself, she suggested, giving the example of stubbing your toe. If you stub your toe, but you are enjoying yourself, and life is going well, it hurts, but it’s not overwhelming. If you stub your toe and you are depressed, say because you just lost your job. That stubbed toe is just 1 more thing happening to YOU—and it is going to feel worse.

The same occurs with animals, she said. Issues such as noise phobia that was never an issue in a dog, but now it’s older, and it is a problem, could be linked to pain, and osteoarthritis can impair a dog’s sleep and affect its mood, she said.
“We all recognize if a horse is showing the behavior of pawing, rolling, flank watching, circling, kicking at its abdomen—we recognize these as the motor outputs of the behavior of abdominal pain. So, we’re then going to investigate for colic,” Dr. Pearson said.

But what about a horse that is pronking or being aggressive or displaying unwanted behaviors. It can be a little harder to differentiate pain from behavior, she said, but she seems to err on the side of pain.

Dr. Pearson shared 3 main differential emotions that are associated with unwanted behaviors: pain, fear and frustration.

“The important point here is that all 3 of these activate the standardized physiological stress response, so you’re going to get similar pathways occurring within the body, and then you’re going to get a lot of similarities within facial expression, and other aspects, which can make it hard to work out which one it is,” Dr. Pearson said.

She said that it is common to think that a mild level of pain yields a mild level of behavioral response, but that is not always necessarily true. “We have to remember that pain is an individual perception,” she said. “The cases I see [are] often very similar to the cases that the sports veterinarians see, they often have very low-grade pathology. The difference is rather than just manifesting as poor performance, in my caseload, pain often manifests as more significant behavioral problems.”

In trying to determine the primary cause of behavioral issues, the first step is to rule out any obvious pain and injury by conducting a clinical examination. A poor response to behavior modification is probably the most reliable indicator that pain or pathology is a significant underlying factor in these cases, she said.
Happy horses will cope with pain; stressed horses will not cope with pain, she explained.

“So, we start to think through the history of these cases, and it can take me an hour to take a history for these more complex cases,” Dr. Pearson said. “If you’ve got an older horse, and it has a sudden onset of behavior, that’s much more likely to be pathology, if nothing else has changed.

“If I’ve got a horse, it’s needle shy but perfectly happy with everything else in life, then it’s probably just needle shy.

“If I’ve got a horse, it’s needle shy, but it also doesn’t like to be clipped and does not like to be bathed, and there’s other things going on there—maybe there’s some skin disease going on.”

When trying to manage either pain or behavior, an in-depth, systemic examination and investigation are warranted, Dr. Pearson she said.

Rule out the obvious causes of pain with a clinical examination and, perhaps an analgesic trial. Rule out obvious behavior issues. Does the horse have friends, is it able to have the freedom to move as it wishes, does it have access to ad-lib forage? Can you retrain an unwanted behavior?

She said she likes to put a camera in the stall and watch the animal at night. Remember these are prey animals, and are pretty darn good at hiding pain, but at night when its alone, you may see a problem, such as itching. And she records the entire night and watches it at a faster replay speed. In 2 videos the horses were trying to scratch and bite themselves. Itching, she reminded is not going to get better with an analgesic trial. When she added a steroid, the animals started to calm down, and she could address the unwanted behavior.

Trying to discern pain will not be a quick process, she warned. Often just taking a complete history can take an hour. MeV