Without getting into the actual details of it, Does anyone else feel heart wrenching guilt about their horse being in pain all the time with a lameness?
There’s nothing you can do to take away the pain for them 
and then, the guilt of realizing they were most likely in pain for a long long time before you realized it was more than a ‘mis-step’.
Is there any relief?
Yes. When my horse injured her hind suspensories she was in pain for a long time, she stopped lying down in fresh shavings since it wasn’t easy to get up. Given the degree of damage we knew it had been getting bad for a long time. However she did get better. And after two years when we get to jump or gallop I can feel how happy she is. She runs and bucks around the field and is a happy healthy horse.
However to this day when I look back on those months I feel extreme guilt over not noticing sooner, about not being able to relive the pain faster. I know I did everything I could and even my vet felt I went past what most owners would’ve done but the guilt is there. She’s my heart horse and means the world to me. I try to focus on how happy she is now and not remember the guilt I feel from that time.
Is it such severe lameness that pain killers like bute, Previcox, Banamine, etc don’t even touch it? Cold hosing/icing doesn’t reduce swelling/pounding pulses?
There should be things you can do to ease discomfort while the horse heals. If nothing is working, the lameness/injury is so severe it may be time to consider other options like humane euthanasia or at the very least serious pain control. I worked at a barn where a horse was on fentanyl patches to control pain. There are extreme options if the horse is that uncomfortable.
A horse that will be in chronic pain for the rest of their life is not living, they are suffering, in my opinion. But I am not clear as to if what you are speaking about is an injury with a decent prognosis or not. Some discomfort during healing a soft tissue injury, a wound that required stitches, recover from surgery, etc is to be expected and as long as there is appropriate pain control you are doing what any good animal owner would do. If the horse is never going to improve and the state they are in is likely their state for life, it is time to consider all the options. You can’t dope up a horse on painkillers for the rest of their life to make them some semblance of sound.
Relief can come from knowing, for sure, that they are not in pain anymore. And I say that knowing how hard it could be to consider putting down a horse you love.
Exactly. If you can’t relieve their pain you euthanize.
It definitely depends on what you mean by lame. There are plenty of horses out there that 1 or 2/5 lame and live long lives that appear to be happy and comfortable enough, some without any painkillers or intervention. A horse with navicular or ringbone might be sound at the walk and slightly lame at the trot for many years, and I wouldn’t worry about its quality of life. A horse that foundered severely or had a catastrophic injury might never be comfortable enough to have a normal horsey life. I want them to be able to live in a small group, get around well, get up and down to sleep and roll, get enough to eat, not get picked on by the other horses. I would consider that a decent life. If they can’t comfortably do that or aren’t happy with it, then I would euthanize. But I am pretty lame myself some days and moderately lame others.
Agreed. I don’t want anyone to think that I would euthanize a horse with mild lameness. But when they are in pain to the extent that they are unable to defend themselves if necessary, cannot/will not lie down because they cannot get up/down, or otherwise are obviously suffering…that is when you know it is time. I had a mare that got to the point that she could not get up after lying down - it would take several attempts, and then she would stand, unmoving, for a while in obvious pain, lip curling. At about that time I spoke with my vet about options and chose to euthanize before winter set in.
This is what euthanasia is for.
I assume you mean this pain is not temporary. Or do you mean it’s intense pain but the prognosis is good AND you/your barn staff can and will do everything prescribed to get the horse to heal? That is to say, you all are asking the horse to the painful wait and you are “keeping up your end of the bargain” by doing all the care right? To an extent, I’d be willing to watch a horse endure some pain in this second scenario, but only with some very good odds and fabulous care.
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