Functional and Chronic Abdominal Pain

The following considerations should be taken into account when assessing ED patients with functional and chronic abdominal pain:

• Any patient who represents to the ED with the same symptoms within a few days of discharge is at high risk of significant pathology
• A few patients will present to the ED with recurrent or chronic abdominal pain. It is important to treat each presentation at face value
• There is a higher mortality rate in frequently attending patients and if in any doubt seek senior staff guidance
• Consider functional abdominal pain in patients who have had previous repeatedly normal investigations and multiple presentations
• Consider social and medical input into these patients through case management
• It may be appropriate to consider referral to chronic pain or mental health teams

Warning signs include patients who repeatedly present to different hospitals, have multiple scars from abdominal surgery or who often self-discharge after being given analgesia (particularly opiates).