Emojis are Here.

The new Visual Analogue Scale


The Standard Sets

Discover the new standard Visual Analogue Scales

Experimental Sets

A whole new world of scales


Before Emojination + Qolty, Visual analogue scales required pen, paper, and expensive fees for trademarked scales.



The Emojination Visual Analogue Scales (VAS) become digital, free, and universal. Emojis are the new Universal VAS

About Our Collaboration

Qolty and Emojination.org are teaming up to provide creators with free, easy to use visual analogue scales in their studies.

Free  & Standard

Our goal is to provide researchers, scientists, and digital health enthusiasts free standardized tools for all visual analog scales. Communication with patients should never be monetized, and because Emojis are a universal language, we think they can serve as the perfect replacement. Emojination.org is a world's standard emoji organization and we've enlisted them to support you.

Visual Analog Scales and Pain Assessment: Introduction

Pain assessment is the key to the effective treatment of both acute and chronic pain. Pain is a multifaceted phenomenon; a mixture of sensory, emotional and cultural experiences. As pain is a complex internal event, self-reports are becoming valuable tools in research and practice. The visual analog scale (VAS), in particular, is one of the most popular subjective measurements used in the effective assessment and treatment of pain intensity.

The visual analog scale, also known as the graphic rating scale is a simple, valid and reliable subjective measure. Interestingly, the scale was used for the first time in 1921, by Hayes and Patterson. The visual analog scale allows patients to assess their pain experiences with high precision. Scores are ranked on a 10-cm line that stretches between two extremes – “no pain” and “worst pain” (Delgado et al., 2018). Note that this scale can be represented as a horizontal or a vertical line. Moreover, the visual analog scale is a versatile continuous scale which can be applied to a wide range of clinical settings, such as labor pain, neuropathic pain, fatigue in chronic pain, and patients’ quality of life.

Benefits and Limitations of Visual Analog Scales

The visual analog scale reveals numerous benefits in medical research and routine clinical care (Kliger et al., 2015). Some of its major strengths are:

  • High sensitivity: One of the main advantages of the visual analog scale over other pain assessments is its high sensitivity. As the scale represents a 100-mm line, patients’ options are not limited to a few verbal descriptors or numbers.
  • Applicable across a wide variety of populations: The lack of verbal descriptors and scores allows subjects with low reading and numerical skills to complete the assessment. Patients have to choose a marker that fits their pain experience and opt for effective pain treatment.
  • Easy to administer and analyze: Visual analog scales are easy and quick to administer. Such tools benefit the reassessment of pain and the comparison of pain experiences between patients, which can improve pain treatment and care.

That said, the visual analog scale has a few limitations. One of the disadvantages of the visual analog scale is the need for clear vision. Research shows the scale can be challenging for 7%-16% of patients who are unable to convert pain experience to an abstract line (e.g., children and mentally challenged patients). In addition, researchers disapprove of the inability to administer the scale remotely (e.g., telephone-based assessments or interactive voice response). Yet, the visual analog scale is one of the most powerful pain assessments used in practice.

Psychometric Properties of Visual Analog Scales

The selection of an appropriate subjective measurement in research and clinical care is paramount, and it’s often based on the psychometric properties of the scale of interest. The visual analog scale, in particular, reveals good psychometric properties, such as validity, reliability, and sensitivity. In fact, research shows that the scale is more sensitive than a four-point verbal rating scale and equally well-accepted as a faces rating scale. The visual analog scale is simple to complete and analyze; it’s also able to identify cut-off scores of patients with clinically significant symptoms (Safikhani et al., 2018).

Interestingly, some researchers suggest that the visual analog scale and the numeric rating scale can be used interchangeably. Nevertheless, Kliger and colleagues conducted a retrospective study, involving 796 patients with chronic pain, and concluded that the two scales could not be defined as interchangeable (Kliger et al., 2015). Despite the high Spearman correlations between the visual analog scale and the verbal rating scale, each measurement has its specific benefits and applications. The interpretation of any subjective scale is also crucial. Note that a change of about 10 mm on a 100-mm visual analog scale is considered clinically significant (Vautier, 2011). In fact, with its good psychometric properties, the visual analog scale reveals numerous benefits over other pain assessments.

Usage and Applications of Visual Analog Scales

The visual analog scale can be applied across numerous clinical settings. The instrument, for instance, is highly beneficial in the measurement of the unidimensional aspects of pain. Patients express preferences of visual analog scales over verbal rating scales as visual analog scales do not limit responses to a number of pain categories (Aicher et al., 2012). Note that when it comes to verbal rating scales, the use of an uneven number of descriptors often leads to regression towards the mean, while the use of more than seven descriptors decreases the reliability of the scale.

Interestingly, Aicher and colleagues assessed the performance of the visual analog scale in patients suffering from severe headaches. Patients were required to draw a line on a 100-mm vertical scale. Visual analog scales showed better sensitivity and acceptance compared to verbal rating scales. As the scale represents a continuous line, the visual analog method reveals high sensitivity. Note that previous research revealed the superiority of the combination of acetylsalicylic acid, paracetamol, and caffeine over the combination without caffeine or the single preparations.

Visual analog scales can be applied to other subjective phenomena, such as tense arousal and mood. The visual analog scale can be used across numerous settings:

  • Mood and depression: Mood assessments and journals are essential for one’s well-being. The visual analog scale, in particular, can help experts detect the first signs of depression which can improve treatment. Research shows that the visual analog scale is a useful tool in the assessment of depressive symptoms, including depression in elderly and cognitively impaired patients.
  • Asthma: Visual analog sc