Dextropropoxyphene: is there still a therapeutic role? - NO

Abstract

The evidence that dextropropoxyphene is “ideally suited for patients with mild to moderate pain” is unconvincing. Furlan et. al.’s meta-analysis of studies in patients with chronic non cancer pain demonstrated that “based on the available trials analysed: [w]eak opioids ([dextro]propoxyphene, tramadol and codeine) did not significantly outperform NSAIDs or TCAs for either pain relief or functional outcomes.” In their systematic review only 17 of the 41 studies were considered to have in fact adequately randomised the research participants; and the average drop out rates of 33% and 38% (intervention vs control) perhaps reflect the difficulties in controlling chronic pain. Of note was that 90% of the trials had either been funded by the pharmaceutical industry or had one or more co-authors affiliated with the pharmaceutical industry.