Consensus report from the Havemeyer Working Group meetings on equine pain assessment

Recognition and assessment of pain in horses remain fundamental yet challenging aspects of equine clinical practice and welfare. Unlike human patients, horses cannot self-report pain, requiring clinicians to rely on behavioural observation, physiological indicators and structured assessment tools. Over the past two decades, numerous pain scales and methodologies have been developed; however, inconsistent adoption in everyday practice persists due to complexity, training requirements and limited applicability across clinical contexts. The Havemeyer Working Group on Equine Pain Assessment convened international experts in equine medicine, anaesthesia, surgery, behaviour and welfare to evaluate current methodologies and establish a pathway toward standardisation. Two consensus meetings were held in Reykjav & iacute;k (2022) and West Chester (2024). The first meeting reviewed existing approaches, including behavioural observation, facial expression analysis, ethogram-based systems, composite pain scales, gait analysis, quantitative sensory testing and condition-specific tools for foals, donkeys and postoperative or chronic pain. Participants concluded that no single method adequately captures the multidimensional nature of equine pain. The second meeting focused on practical implementation. Among available instruments, the Equine Pain Scale (EPS) was identified as the most feasible candidate for routine clinical use due to its brevity, multidimensional structure and demonstrated reliability across observers. The Working Group emphasised that successful implementation requires education, integration into electronic medical records and multicentre data collection rather than further proliferation of new scales. Overall, the consensus report highlights the need to treat pain assessment as a core clinical vital sign. Immediate adoption of standardised, practical scoring - particularly the EPS - combined with ongoing validation studies and emerging technologies such as automated video analysis represents the most effective strategy to improve equine welfare and clinical decision-making.