Horses are stoic animals that often conceal pain signs until conditions are severe. Improved pain recognition tools and wider analgesic use are important welfare advances in equine medicine.
Pain recognition in horses is challenging because their stoic nature and human economic interests in their performance create pressure to overlook welfare concerns. Behavioral changes that indicate pain — reluctance to work, bucking, head-tossing, poor performance — are often attributed to behavior problems and addressed with training interventions rather than veterinary investigation. The Horse Grimace Scale and other validated assessment tools provide more objective pain assessment, but require training and time to use. Equine gastric ulcer syndrome affecting up to 90% of racehorses represents a massive welfare issue caused by management practices including intermittent feeding and intensive training. Pain management culture in horse sports requires significant improvement.