Objectives: The aim of this study was to determine the reliability and validity of a new pain measurement tool, Pictorial Representation of Pain (PRP), in order to determine its ability to measure the intensity of pain and burden of pain for patients in Emergency Department (ED). Methods: Pictorial Representation of Illness and Self Measure (PRISM) has been used as a tool in psychiatric interviews in order to determine the burden of an illness. With modification, a new software named PRP was developed for use in Akdeniz University Hospital ED (Antalya, Turkey). Patients presented to the ED with acute pain were enrolled into the study. Study patients were asked to rate their pain levels at 0, 1, 30, 31, 60 and 61 minutes with PRP and a verbal descriptive scale in order to determine the minimum clinically significant difference. Results: A total of 246 patients were included into the study with mean age of 40.6+/-15.4. Eighty seven (35%) were men. The correlation coefficient between PRP scores one minute apart were 0.95 (95% CI: 0.94 to 0.96), 0.95 (95% CI: 0.93 to 0.96) and 0.98 (95% CI: 0.83 to 0.99) at the three preset time (0 min, 30 min, 60 min) respectively. And the overall correlation coefficient was 0.96 (95% CI: 0.96 to 0.97). The minimum clinically significant change in pain was 28.7 mm (95% CI: 27 to 30) with a median of 28 mm (IQR: 23-34, 95% CI: 26 to 30). Conclusions: PRP could be considered as a reliable and consistent tool for measuring the intensity of pain. However, further studies are needed to determine the use of PRP in measuring burden of pain.