popular with both prescribers and patients; its popularity may be influenced by a mild euphoriant effect of the opioid, to which dependence can occur. A major concern is that in (deliberate) overdose death may occur within one hour due to the rapid absorption of the dextropropoxyphene, and combination with alcohol appears seriously to add to the hazard. We do not attempt to rank the many preparations available because comparative evidence is lacking.

Pain syndromes and their treatment

In general, pain (acute or chronic) arising from the somatic structures (skin, muscles, bones, joints) responds to NSAIDs. Acute pain arising from viscera, which is poorly localised, unpleasant, and associated with nausea is best treated with morphine but this induces dependence with prolonged use. This distinction is not, of course, absolute and a high-efficacy opioid is needed for severe somatic pain, e.g. a fractured bone. Mild pain from any source may respond to NSAIDs and these should always be tried first.

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