Many horse owners use complementary and alternative veterinary medicine (CAVM) in the treatment of equine musculoskeletal back pain (EMBP) without informing their regular veterinarian. This study explored veterinary attitude and behavior toward CAVM and integration of CAVM in treatment of EMBP. A web-based survey was distributed to equine veterinarians via social media. Of the 127 respondents, 71% worked in equine specialty practice. The highest proportion of respondents (51/118, 43%) worked predominantly with sport horses. Forty-two percent reported examined horses with EMBP once or more a week. Attitude toward CAVM was positively correlated with CAVM training (P < .001, rs = 0.40), as well as examining horses with EMBP more frequently (P < .001, rs = 0.32). Respondents who provided acupuncture and chiropractic examined horses with EMBP more frequently than respondents who did not provide acupuncture (P = .001) and respondents who did not provide chiropractic (P = .002). Respondents were most familiar with acupuncture and chiropractic and had referred more often to chiropractic (71%), acupuncture (63%), and massage (61%) than physiotherapy (32%). Forty-four percent of respondents provided acupuncture, 33% chiropractic, 16% physiotherapy, and 13% massage. Results indicate a level of knowledge and integration of CAVM into EMBP treatment that does not seem to warrant owner exclusion of veterinarians from the decision to use CAVM but rather suggest opportunities for veterinarians to function as educators regarding CAVM and facilitate inclusion of CAVM into the treatment of EMBP to optimize horse welfare.