There are several conditions and diseases considered painful to cattle. One reason for the inconsistency in pain recognition and thus pain relief in cattle is the inadequate ability to identify and assess pain. In fact, both increased and/or reduced daily lying time can be indicative of pain in cattle. This review helps to properly interpret pain in cows through behavioural activity patterns and explores whether pain relief is capable to restore their normal activity. The main conditions and diseases considered painful in dairy cows are mastitis, lameness, calving (including dystocia and caesarean section) and metritis. The cattle literature reports that deviation from normal daily activity patterns (both increased and/or reduced daily lying time) can be indicative of painful conditions and diseases in cows. This narrative review discusses on how pain due to several health conditions in dairy cows modifies its activity pattern and explores if non-steroidal anti-inflammatory drugs (NSAIDs) are capable of restoring it. Divergent outcomes may differ depending upon the painful cause, the severity and the moment, and consequently its interpretation should be properly explained. For instance, cows with clinical mastitis reduced their time lying and increased the number of lying bouts and stepping due to pain caused by the swollen udder when cows are lying. However, lame cows show longer lying times, with a lower number of lying bouts and longer and more variable lying bouts duration, as compared to non-lame cows. When the relationship between painful disorders and daily activity patterns is studied, factors such as parity, bedding type and severity of disease are important factors to take into consideration. The potential benefits of the NSAIDs treatment in painful health disorders depend upon the type of drug administered, its dosage and administration mode, and the time of administration relative to the painful health disorder. This narrative review can be used as a tool to properly interpret and grade pain in cows through behavioural activity patterns and proposes directions for future investigations.