Dextropropoxyphene is a mild opioid analgesic whose analgesic potency corresponds to that of acetylsalicylic acid and paracetamol. It has a similar analgesic effect to codeine but also a considerably lower addiction and dependence potential. Dextropropoxyphene is a therapeutic alternative to other weak opioids such as codeine or dihydrocodeine. In the case of absolute intolerance of non-steroidal anti-inflammatory agents, their analgesic effect can be replaced by that of dextropropoxyphene. In case of relative intolerance, i.e. occurrence of non-tolerable side-effects, the dose of non-steroidal anti-inflammatory agents can be kept low by additional administration of dextropropoxyphene, which simultaneously enhances analgesia. Analgesics are prescribed according to a definite time schedule for the long-term treatment of chronic pain. The oral route of administration is preferred since it enables the patient to be independent of the nursing staff. Sustained-release drugs with a duration of action of at least 8 h are used in preference to other preparations. Sustained-release dextropropoxyphene provides analgesia for 8-12 h. Sustained-release dextropropoxyphene clearly differs from non-sustained-release dextropropoxyphene in its pharmacokinetics. Repeated administration of the sustained-release form at the therapeutically recommended intervals does not lead to cumulation, and the risk of accidental overdosage is extremely low. Intoxication can only occur after simultaneous ingestion of alcohol or other centrally depressant substances or in the presence of hepatic and/or renal failure. Sustained-release dextropropoxyphene is a sensible and undeniable alternative for the second stage in the analgesic ladder of chronic pain therapy.