Ulcers, back pain, foot pain, mouth pain… did I mention pain? A few anecdotes:
My lovely boy, when he was 4 and 5, would get spooky in one specific spot out hacking, where he had to walk on pavement. When we started going further, another specific spot set him off to the point of bucking me off. It was very rocky there. We put shoes on him and his whole demeanor in those two spots changed. No more spooking or being anxious hacking. He never came up positive on hoof testers or was every visibly lame. In fact, there is no visible or internal reason that we can see for him to be happier in shoes (we’ve done x-rays and everything, he has amazing feet).
Same horse, as a 6yr old, we decided to scope for ulcers while doing a few other horses at the barn. Lo and behold, he had mild to moderate ulcers. Treated with sucralfate and gastroguard. Right away he was much braver and less spooky. I rode before his sucralfate one morning to beat the heat and he was much spookier again. Now he gets sucralfate whenever he travels, much quieter all around.
A different horse has always been weirdly spooky and anxious. Generally very sane but would get very tight and nervous about an arena door, or a corner of the arena. He developed an intermittent lameness, first thought was a front suspensory. Treated did all the things, he returned to work but continued to have a small head bob that he would work out of. Finally sent him for a full body bone scan. It lit up three spots, the LF where he would look lame, his hocks, and his lower back. Did blocks. When they finally blocked his back, he stopped spooking at the spot in the arena instantly. Injecting his back made a huge difference, he was sound and not spooky (and a whole new horse in some regards). Unfortunately, imaging doesn’t give us any reason for the soreness, saddles fit (confirmed multiple times), feet are in good balance, so we are just focusing on strength building and counter conditioning.
What it boils down it is being in pain makes anyone anxious, even if that pain isn’t something that can be easily located.