When numbers fail us, can emojis take their place?
Some researchers suggest that emojis may provide new routes for patients to articulate pain, especially for people whose medical complications or language barriers impede their ability to voice distress. For example, people experiencing a stroke may have aphasia, which inhibits their ability to communicate and process numbers.
Shuhan He, MD, who led a study on the success of using an emoji pain scale in a hospital, is developing new emojis for medical use. Visual pain scales like the Wong-Baker FACES pain rating scale are already being used in medical offices, but an emoji scale is slightly different, according to He.
The Wong-Baker scale is a picture-based pain scale that is used to assess a patient’s pain level. The scale features five facial expressions that are numbered from 0 to 10, and it represents a range of emotions, from distressed to joyful.
An emoji scale is linguistically accessible, He explained. People who speak various languages or dialects tend to use the same or similar emojis over text. These near-universal characters represent things that people commonly relate to or understand regardless of their native tongue: facial expressions, clothing, household items, shapes, and more.
“When using an emoji scale, you’re really talking about a visual language, much like the Chinese language,” He told Verywell. “For a long time, humanity has used these visual languages to be very expressive. You’re not just giving data, you’re also giving emotions, which is a very, very powerful thing.”
Emojis are also compatible with virtually any digital device, he added, which makes implementations easier.
He explained that Wong-Baker users sometimes need to download a specific app to use the scale in their offices. They can bypass the digital route by printing out the scale and have patients point to the face that reflects their pain level. While this may seem like an easy solution, a physical scale will not be helpful for tracking a patient’s pain level over time—a crucial step in assessing care and recovery.
“What we really want is for the patient to give us data [on their pain] every second of the day, every time they go for a walk, when they get out of bed, when they go for breakfast, when they walk their dog,” He said. “The only way to do that is not a paper diary, it’s digital data.”
Another important benefit of an emoji pain scale is its range of expressions. In comparison to a numerical pain scale—or even the Wong-Baker scale which includes 5 faces—there are over 3,600 emojis, about 100 of which are facial expressions.
“It’s no longer ‘10’ that is the highest level of pain,” He said. “Everyone will have a different baseline, and we need to be able to individualize this.”
For example, a patient experiencing severe pain may choose an emoji with a small frown (🙁). In a follow-up appointment, if the pain has not improved at all, the patient might want to use a more dramatic emoji with streams of tears (😭). As their pain continues to change—and hopefully subsides—they may point to a neutral face (😐), or eventually a smile (😀).
Currently, He is only testing out a scale with five emoji faces. In the future, his team hopes to include more expressions and pair those with other indicators of pain severity, like a knife emoji (🔪) or a flame emoji (🔥). In comparison to a numbered scale, these multiple options would allow patients to express pain levels above that number 10 threshold.
Anyone who’s well acclimated to the emoji-verse will know that emojis can have multiple meanings, and they can be prone to misinterpretations.
For example, what one person uses as an emoji to express pain, another could use it to express sarcasm or annoyance. This could complicate a healthcare provider’s ability to understand the patient.
“It may be that someone actually sees 😭 as sarcasm, or a happy state, and not severe pain,” He said. “But that’s also the same issue with the Wong-Baker or other visual analog skills.”
Going forward, healthcare providers can start to think of these visual scales as “dynamic languages,” which require more research and studies, He added. As emoji becomes more popular in medical settings, it will be important to track people’s interpretations of different emojis and make sure providers are aware of what their patients are expressing.
In addition to an expression-based pain scale, He and his team are experimenting with other ways of bringing emojis into healthcare conversations.
A combination of emojis may also help diagnose the source of pain. For example, a thundercloud emoji and an explosive head emoji (🌩🤯) together could represent a thunderclap headache, which could indicate life-threatening brain disorders.
He also suggested that an elephant emoji plus a heart or chest emoji (🐘🫀) can be used to represent heavy chest pain or a heart attack. Feeling like an elephant is sitting on your chest is a description “extremely specific” to a heart attack, he added, and it could give providers more details to work with.
He is also creating and proposing these new medical emojis through an advocacy project. So far, he’s created and launched the anatomical heart (🫀) and lung (🫁) emojis. He’s proposing more, including a liver, stomach, spine, and a bag of blood, which he hopes can add some muscle to people’s medical vocabulary and ability to describe pain.
“I always think about somebody with a child with stomach cancer, or intestinal cancer, or liver cancer,” He said. “How does that make them feel when there is no emoji that represents them in their condition? That’s a fundamental representation issue that needs to change.”
Instead of a numbered pain scale, you might be able to express your pain through emojis in the future, especially if you're struggling with verbal communication.