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 broad spectrum of possible causes, abdominal pain presents as a significant clinical challenge within the ED, particularly as distress and pain is commonly elevated. Patients in this group are routinely prescribed opiate based interventions and repeated investigations in a ‘better safe than sorry’ culture which saturates medically unexplained 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 current 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.