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Research article2020Peer reviewedOpen access

Identification of Body Behaviors and Facial Expressions Associated with Induced Orthopedic Pain in Four Equine Pain Scales

Ask, Katrina; Rhodin, Marie; Tamminen, Lena-Mari; Hernlund, Elin; Haubro Andersen, Pia


Simple SummaryPain scales are tools developed to improve pain assessment in horses. They are based on behaviors and/or facial expressions, and the observer allocates a score based on the character of the behavior or facial expression. Little is known about behaviors and facial expressions at rest in horses with orthopedic pain since pain is mainly assessed by lameness evaluation during movement. The aim of this study was to describe how closely equine behaviors and facial expressions are associated with movement asymmetry and to identify combinations of behavior and expressions present in horses with induced orthopedic pain. Orthopedic pain was induced in eight horses and assessed in two ways; using four existing equine pain scales at rest, and by measuring movement asymmetry during movement. The association of behavior and facial expression items in the pain scales with actual lameness was analyzed. Posture-related behavior showed the strongest association, while facial expressions varied between horses. These results show that pain scales for orthopedic pain assessment would benefit from including posture, head position, location in the box stall, focus, interactive behavior, and facial expressions. This could improve orthopedic pain detection in horses during rest with mild lameness.Equine orthopedic pain scales are targeted towards horses with moderate to severe orthopedic pain. Improved assessment of pain behavior and pain-related facial expressions at rest may refine orthopedic pain detection for mild lameness grades. Therefore, this study explored pain-related behaviors and facial expressions and sought to identify frequently occurring combinations. Orthopedic pain was induced by intra-articular LPS in eight horses, and objective movement asymmetry analyses were performed before and after induction together with pain assessments at rest. Three observers independently assessed horses in their box stalls, using four equine pain scales simultaneously. Increase in movement asymmetry after induction was used as a proxy for pain. Behaviors and facial expressions commonly co-occurred and were strongly associated with movement asymmetry. Posture-related scale items were the strongest predictors of movement asymmetry. Display of facial expressions at rest varied between horses but, when present, were strongly associated with movement asymmetry. Reliability of facial expression items was lower than reliability of behavioral items. These findings suggest that five body behaviors (posture, head position, location in the box stall, focus, and interactive behavior) should be included in a scale for live assessment of mild orthopedic pain. We also recommend inclusion of facial expressions in pain assessment.


horses; movement asymmetry; movement symmetry; lameness; reliability; pain predictor; pain indicator

Published in

2020, Volume: 10, number: 11, article number: 2155
Publisher: MDPI