Why ruling out pain can be tricky
A lot of training and behavioural issues stem from pain, but sometimes finding the true cause of pain can be tricky. This is especially true because pain does not necessarily reflect tissue damage.
Signs of pain or even the source of pain might not always be obvious. In order to be responsible owners, we need to get really good at recognising when something is not right. The facial expression is always a good place to start.
When encountering any sort of behavioural or training issue with our horse, our first job is to rule out pain. Your horse started to refuse jumps – check for lameness. Your horse started to bite while being tacked up – check for back pain and stomach issues. Your horse started stumbling and can't lift the base of the neck – check the hoof balance and thoracic sling restrictions. And so on ad infinitum. Finding the source of pain can sometimes be a real detective job. We might have the vet out, followed by the saddle fitter, the bodyworker, the hoof care professional... It can be a windy road. In most cases, with patience and diligence, the issues can be fixed and the horse can go on with their happy life. But sometimes finding the real cause of pain is very, very tricky. Here's why.
When we think of pain, we often think of it as »an alarm system warning our brain of damage to a body part«. You out your hand on a hot stove – the brain sends pain signals that motivate you to move your hand, preventing further damage to the tissues. But it's not always this simple. To understand that, we need to understand what pain is. (A caveat here - the science around pain is very complex (and fascinating!), so the following will be a huge simplification.) Pain is not created in the body part that hurts; pain is created in the brain. Nerve endings send information about what is happening to a body part to the brain and it's the brain that determines whether or not to classify this as a painful experience. Keep that in mind. There are different kinds of pain out there. We have talked about some of those before, LINK, mainly the difference between »normal« pain and neuropathic pain. But there is another type of pain, one that I think we see in horses very often.
It's called nociplastic pain and it's different to nociceptive pain (pain due to tissue damage) and neuropathic pain (pain due to nerve damage). It's pain that happens due to changes in how the nervous system processes pain signals. So, a signal that would normally be labelled as »slight pressure«, »warmth«, »slight stretch« can be interpreted by the nervous system as painful. This leads to lowered pain threshold and increased pain perception. Obviously, that can be very, very problematic with horses. We may have a horse that is showing signs of pain, and yet the equine professionals on our team can't seem to find anything that's »wrong«, there's no tissue damage. At this point, many owners might conclude that the horse has a behavioural issue and might try to »train the horse out of it«. But just because there is no tissue damage, it does not mean that the pain isn't there.
So, how do we even begin to address this problem? Obviously, it can be tricky. First of all, if the horse is showing signs of pain, believe that it is pain, even though we can't find a cause. In humans, nociplastic pain is addressed in a multi-layered way. Resolving the problem consists of an appropriate exercise regime, physical therapy and bodywork, a systematic desensitization plan as well as psychotherapy and medication. The approach for horses will be slightly different, but the basic ideas stay the same. Next week, we'll get into a little more detail about what can be done and how to go about doing it.