Measuring the Pain Area: An Intra- and Inter-Rater Reliability Study Using Image Analysis Software. 
Pain drawings have frequently been used for clinical information and research.  The aim of this study was to investigate intra- and inter-rater reliability of area measurements performed on pain drawings.  Our secondary objective was to verify the reliability when using computers with different screen sizes, both with and without mouse hardware.  Pain drawings were completed by patients with chronic neck pain or neck-shoulder-arm pain.  Four independent examiners participated in the study.  Examiners A and B used the same computer with a 16-inch screen and wired mouse hardware.  Examiner C used a notebook with a 16-inch screen and no mouse hardware, and Examiner D used a computer with an 11.6-inch screen and a wireless mouse.  Image measurements were obtained using GIMP and NIH ImageJ computer programs.  The length of all the images was measured using GIMP software to a set scale in ImageJ. Thus, each marked area was encircled and the total surface area (cm(2) ) was calculated for each pain drawing measurement.  A total of 117 areas were identified and 52 pain drawings were analyzed.  The intrarater reliability between all examiners was high (ICC = 0.989).  The inter-rater reliability was also high.  No significant differences were observed when using different screen sizes or when using or not using the mouse hardware.  This suggests that the precision of these measurements is acceptable for the use of this method as a measurement tool in clinical practice and research.