How to tell if your horse is in pain
By Cristina Wilkins and Dr Karina Bech Gleerup
Horses may not be able to say how much it hurts with words, but researchers show their face tells all. Learn to recognise the signs of the equine pain face, also known as the equine grimace scale, with Karina Bech Gleerup.
Recognising pain and pain intensity in horses has been a challenge for veterinarians and anaesthetists, making it difficult to assess if horses are receiving appropriate pain relief. New research, however, shows that, as happens in humans and other animals, certain facial expressions can indicate a horse is in pain, and that learning to recognise the signs is relatively easy and feasible for veterinarians, nurses and horse owners alike.
To download your FREE Equine Pain Face Poster
https://mailchi.mp/horsesandpeople/equine_pain_face_poster
The findings follow the publication this year of two important studies. A team of researchers from Italy, Germany and the United Kingdom were first to publish a standardised pain scale based on facial expressions in horses. Similar to the Body Condition Scoring system, the Horse Grimace Scale (HGS) recommends scoring a number of different facial expressions and add them to produce a final pain-intensity score.
A team of researchers from Denmark and Sweden followed up with another study that, not only agrees that facial expressions of pain can be appreciated in horses, but suggests an easier way for people to recognise the pain face.
The study shows that it is possible to score a ‘pain face’ as a simple yes/no (instead of using a scale), and that the intensity of the expression may be sufficient. This makes Gleerup’s Equine Pain Face more applicable than the Horse Grimace Scale.
Karina Bech Gleerup, a veterinarian and lecturer from the University of Copenhagen, presented a poster of the findings at the 10th International Equitation Science Conference, Denmark.
A Simplified Approach
Bech Gleerup and her team have identified five key areas to watch out for:
• ears,
• eyes,
• nostrils,
• muzzle and
• facial muscles

(a) Facial expression of a pain free, relaxed and attentive horse (Ill. Andrea Klintbjer). (b) Facial expression of a horse in pain, comprising all features of the pain face including asymmetrical ears (Ill. Andrea Klintbjer). (c) Facial expression of a horse in pain, comprising all features of the pain face including low ears
They also showed that learning to recognise facial expressions of pain is feasible. After a 20 minute lesson, the participants were able to successfully score a pain face (yes/no) and grade the pain intensity as ‘low’, ‘medium’ and ‘high’ with, on average, 82% accuracy.
Gleerup says: “We think it is really important that more people learn to recognise pain in their horses.”
Although horses usually become less social when in pain, Gleerup has noticed her own horses displaying contact seeking behaviour while in pain.“This may be important for owners because contact seeking behaviour towards the people the horse trusts may be the first sign of pain” said Gleerup. “All my own research horses displayed this behaviour in a more or less obvious manner and I have seen it in patients too.”
Gleerup added that learning to recognise the equine pain face in their horses may help owners identify chronic or low grade pain at an earlier stage.
The study titled: An Equine Pain Face by Karina B Gleerup, Björn Forkman, Casper Lindegaard and Pia Andersen is open access and available here –
https://www.sciencedirect.com/science/article/pii/S1467298716301325
Thank you to Cristina Wilkins of Horses and People Magazine.