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Assessment and management of recurrent abdominal pain in the emergency department
  1. Jo Daniels1,2,
  2. Mark Griffiths3,
  3. Emma Fisher4
  1. 1 Department of Psychology, University of Bath, Bath, UK
  2. 2 Department of Clinical Health Psychology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  3. 3 Department of Clinical Health Psychology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  4. 4 Department for Health, University of Bath, Bath, UK
  1. Correspondence to Dr Jo Daniels, Psychology, University of Bath, Bath BA2 7AY, UK; j.daniels{at}


Recurrent abdominal pain accounts for a significant proportion of attenders and high impact users in the emergency department. Due to the heterogeneity of presentation and the broad spectrum of possible causes, abdominal pain presents as a significant clinical challenge within the emergency department, particularly as distress and pain are commonly elevated. Patients in this group are routinely prescribed opiate-based interventions and repeated investigations in a ‘better safe than sorry’ culture which saturates the field of persistent physical symptoms. This approach is contributing to the growing problem, and fuelling a cycle of repeated attendance and failure to resolve. This article reviews the current clinical and psychophysiological understanding of recurrent abdominal pain, critiquing guidelines and approaches to diagnosis and management. We offer an alternative evidence-based biopsychosocial approach using the mnemonic ‘ERROR’, recommending five steps to assessment and clinical management of recurrent abdominal pain in the emergency department.

  • abdomen
  • pain management
  • analgesia/pain control

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  • Contributors JD: primary contributor to the content and outline of the paper. EF: contributed also contributed to the content and sourcing of papers, with MG contributing to the clinical aspects of the paper. All authors reviewed and approved the final version and revisions of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.