What “Red Flags” Should the Emergency Clinician Be Aware of When Evaluating the Patient with Chronic Abdominal Pain?

  • Herman Kalsi
  • Janet Smereck


Chronic abdominal pain patients represent a diverse population of patients that require an open mind and judicious management strategy. It is incumbent on the emergency care provider to be aware of “red flags” which indicate the presence of an acute, undiagnosed, or alternative etiology for a chronic pain flare. In addition, the “red flags” which alert the emergency care provider to the possibility of malingering or opiate-seeking behavior will guide the clinician to an appropriate management and disposition.


Chronic abdominal pain Red flags High risk 


  1. 1.
    Zackowski S. Chronic recurrent abdominal pain. Emerg Med Clin North Am. 1998;16(4):877–94.CrossRefGoogle Scholar
  2. 2.
    Tolba R, Shroll J, Kanu A, Rizk M. Ch 2. The epidemiology of chronic abdominal pain. In: Kapural L, editor. Chronic abdominal pain: an evidence-based, comprehensive guide to clinical management. New York: Springer; 2015. p. 13–24., 2.Google Scholar
  3. 3.
    Hauser W, Layer P, Henningsen P, Kruis W. Functional bowel disorders in adults. Dtsch Artebl Int. 2012;109(5):83–94.Google Scholar
  4. 4.
    Hansen G. Management of chronic pain in the acute care setting. Emerg Med Clin North Am. 2005;23:307–38.CrossRefGoogle Scholar
  5. 5.
    Jones R, Charlton J, Latinovic R, Gulliford M. Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study. BMJ. 2009;339:b3094.CrossRefGoogle Scholar
  6. 6.
    Grover C, Wielo E, Close RJ. Narcotic bowel syndrome. J Emerg Med. 2012;43(6):992–5.CrossRefGoogle Scholar
  7. 7.
    Grover C, Elder J, Close R, Curry S. How frequently are “classic” drug-seeking behaviors used by drug-seeking patients in the emergency department? West J Emerg Med. 2012;13(5):416–21.CrossRefGoogle Scholar
  8. 8.
    Moore TM, Jones T, Browder JH, et al. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009;10:1426–33.CrossRefGoogle Scholar
  9. 9.
    McNabb C, Foot C, Ting J, et al. Diagnosing drug-seeking behavior in an adult emergency department. Emerg Med Australas. 2006;18:138–42.PubMedGoogle Scholar
  10. 10.
    Todd K. Pain and prescription monitoring programs in the emergency department. Ann Emerg Med. 2010;56(1):24–6.CrossRefGoogle Scholar
  11. 11.
    Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med. 2004;43:494–503.CrossRefGoogle Scholar
  12. 12.
    Tamayo-Sarver JH, Dawson NV, Cydulka RK, et al. Variability in emergency physician decision making about prescribing opioid analgesics. Ann Emerg Med. 2004;43:483–93.CrossRefGoogle Scholar
  13. 13.
    Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989;7:620–3.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Herman Kalsi
    • 1
  • Janet Smereck
    • 1
  1. 1.Department of Emergency MedicineMedStar Georgetown University HospitalWashington, DCUSA

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