This article discusses the challenges of visually representing pain qualities in pictogram design. An existing set of 12 pictograms designed for people with literacy problems was evaluated to understand more about misunderstandings of pictogram interpretation. Two sets of university students from different disciplines were asked to interpret the pictograms, and a novel classification system was developed to categorise answer types, as ‘location’, ‘affective’, temporal’ or ‘literal’. Several design recommendations are made as a result that will help improve the design of pain pictograms as a whole as well as guide designers of related pictogram work. We demonstrate how, through the robust classification of incorrect responses, it is possible to extract useful comprehension error patterns to inform future design.
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