For mild to moderate pain, which opioids are recommended?

• A. Morphine
• B. Hydromorphone
• C. Butorphanol or Buprenorphine
• D. Fentanyl

Answer: (C)

When choosing an opioid for mild to moderate pain, the goal is to provide enough analgesia with the fewest safety concerns and less intensive monitoring. Butorphanol and buprenorphine fit this role nicely. Butorphanol acts as a kappa agonist with mu antagonism, delivering sufficient pain relief for mild to moderate cases while reducing the risk of respiratory depression and other mu-related side effects. Buprenorphine is a partial mu agonist with very high receptor affinity and a long duration of action, giving sustained analgesia with a favorable safety profile and less frequent dosing.

In contrast, morphine, hydromorphone, and fentanyl are potent mu agonists offering strong analgesia, but they come with higher risks of respiratory depression, nausea and vomiting, dysphoria, and more intensive monitoring or administration constraints, making them more suited to moderate-to-severe pain or intraoperative scenarios rather than first-line for mild-to-moderate cases.