There are obviously systemic pain relief meds used for horses. Vets aren’t limited to local pain relievers for procedures more invasive than stitches,
It’s up to us to be our horses’ advocates and insist on pain meds. This discussion reminds me of when vets sent cats and dogs home after spays and neuters with no pain meds. Those protocols have changed recently and large-animal treatment needs too as well.
None of my horses have had joint injections, but I’ve had them in my shoulder joint and even with both a local and novacaine/lidocaine (?) added to the cortisone, the pain was terrible. Why wouldn’t it be the same for them?