Guide to Veterinary Prescribed Pain Medications for Horses

By: Shannon J. Murray, DVM, MS, DACVS-LA | Updated x 2025

When a horse is in pain—whether due to injury, surgery, or chronic disease—getting the right treatment is critical to their well-being and recovery. While complementary therapies can support long-term pain management, prescription medications often play a key role in providing immediate relief. In this article, we explore the types of veterinary-prescribed pain medications for horses, how they work, and when they may be used.

Keep in mind, certain drugs are strictly regulated and can only be administered by your horse’s veterinarian. Always consult your veterinarian to determine the most appropriate treatment for your horse’s specific condition.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) for Pain Management

NSAIDs are used in surgical, acute, and chronic pain management to treat inflammation. NSAIDs may be administered via a topical, oral, or intravenous route, and they are relatively easy to access and inexpensive for horse owners.

How do NSAIDs work?

These drugs act on the inflammatory pathway that involves inhibiting COX enzymes. The COX-1 and COX-2 pathways are two different ways in which the horse’s body produces prostaglandins – chemicals that help control pain, inflammation, and many other functions in the body. COX-1 is like the body's “helper,” maintaining normal functions, while COX-2 is activated when there’s inflammation or injury.

• Flunixin meglumine and phenylbutazone (Banamine® and bute respectively) are commonly used equine pain medications that act on both COX pathways. However, blocking the COX-1 pathway can lead to side effects, such as stomach ulcers, diarrhea, and kidney issues.
• Firocoxib (commonly known as Equioxx ®) is a COX-2 selective NSAID noted to have less side effects than other NSAIDs. It is often recommended for horses requiring treatment for a longer period.

Corticosteroids for Equine Pain Management

Intra-articular injections (when medications are delivered directly into a joint) with steroid medications, such as triamcinolone acetate or methylprednisolone acetate, are used to reduce inflammation and pain associated with joint disease. For example, a horse with osteoarthritis may receive a joint injection of a steroid to reduce inflammation and slow the degradation of joint cartilage, therefore reducing pain and helping preserve their soundness.

Prednisone and dexamethasone are corticosteroids commonly used in horses to help manage inflammation and reduce pain. These drugs work by mimicking the body’s natural hormones that control inflammation, making them useful for conditions like allergic reactions, joint inflammation, or respiratory issues. Dexamethasone is typically more potent and faster acting than prednisone. These steroids are generally not used long-term because of the risk of side effects, such as suppressing the immune system or interfering with normal hormone production.

Opioid Medications

Opioids, such as morphine and butorphanol, are considered effective in managing pain in horses and are often used in combination with other therapies. Opioids are often administered in a veterinary hospital setting due to the licensing and record keeping required [2]. One use case of morphine may be in the anesthetic protocol in horses undergoing upper airway surgery to improve the quality of recovery [9].

Local Anesthetics for Targeted Pain Relief

Local anesthetics can be applied topically, as well as via intra-articular, perineural, and epidural routes to decrease or inhibit a horse’s pain sensation. One example of a local anesthetic is lidocaine, which could be administered through an IV to a hospitalized colicking horse to help manage their pain [3, 4, 7].

Alpha-2 Adrenoceptor Agonists

These therapies, including xylazine and detomidine, act on alpha-2 receptors scattered throughout the equine nervous system. Alpha-2 adrenoceptor agonists help modulate pain and cause a sedative effect. These drugs may also be referred to as a pharmacologic restraint, allowing for both veterinarians and handlers to safely examine a patient, while limiting stress for that equine patient. For example, alpha-2 agonists could allow a veterinarian to more safely examine a colicking horse that may be violently rolling or inflicting harm onto themselves, while concurrently reducing the horse’s pain.

Other Types of Horse Pain Medicine

Additional drugs you may hear your veterinarian mention that are associated with pain management include:

• Ketamine: Used for severe pain in hospitalized horses. It decreases central sensitization (hypersensitivity to sensory signals) as well as hyperalgesia (when it is normal to feel pain, but the level of pain felt is severe or excessive) [1, 3].
• Gabapentin: Used for neuropathic (nerve) pain, often for cases of laminitis [1].

Partnering With Your Veterinarian for a Comprehensive Plan

Pain management is a critical part of equine healthcare and understanding the medications available can help you be a better advocate for your horse. From NSAIDs to opioids, a variety of drugs may be available to treat your horse’s pain based on its cause and severity. Work closely with your veterinarian to evaluate the risks and benefits of each option and to create a comprehensive, evidence-based plan tailored to your horse’s individual needs. For a holistic approach, consider combining pain medications with complementary therapies, nutraceutical support, and management strategies.

Evidence-Based References

1. Daglish, Jodie, and Khursheed R Mama. “Pain: Its Diagnosis and Management in the Rehabilitation of Horses.” The Veterinary clinics of North America. Equine practice vol. 32,1 (2016): 13-29. doi:10.1016/j.cveq.2015.12.005
2. van Loon, J P A M, and M C Van Dierendonck. “Objective pain assessment in horses (2014-2018).” Veterinary journal (London, England : 1997) vol. 242 (2018): 1-7. doi:10.1016/j.tvjl.2018.10.001
3. Muir, William W. “Pain: mechanisms and management in horses.” The Veterinary clinics of North America. Equine practice vol. 26,3 (2010): 467-80. doi:10.1016/j.cveq.2010.07.008
4. Love, EJ. “Equine Pain Management”. Equine Surgery. Auer and Stick. 263-268.
5. Guedes, Alonso. “Pain Management in Horses.” The Veterinary clinics of North America. Equine practice vol. 33,1 (2017): 181-211. doi:10.1016/j.cveq.2016.11.006
6. de Grauw, J C, and J P A M van Loon. “Systematic pain assessment in horses.” Veterinary journal (London, England : 1997) vol. 209 (2016): 14-22. doi:10.1016/j.tvjl.2015.07.030
7. Mama, Khursheed R, and Rachel C Hector. “Therapeutic developments in equine pain management.” Veterinary journal (London, England : 1997) vol. 247 (2019): 50-56. doi:10.1016/j.tvjl.2019.02.010
8. Adair, Steve. “Integrative Philosophy: Case Management.” The Veterinary clinics of North America. Equine practice vol. 38,3 (2022): 455-461. doi:10.1016/j.cveq.2022.06.004
9. Love, E.J., Lane, J.G. and Murison, P.J. “Morphine administration in horses anaesthetized for upper respiratory tract surgery.” Vet. Anaesth. Analg. (2006) 33, 179-188.