Ketamine, alcohol, nitrous oxide… short acting injectable local anesthetic. None are reasonable for chronic pain management. Additionally the evidence for gabapentoids working outside neuropathy is extremely poor.

I didn’t say all were impractical, I said many.

…and high dose NSAIDs will end up killing more of your chronic pain patients than opioids.

Obviously multimodal is the way to go, but it’s also wrong to pretend we have easy, effective solutions for opioid replacement.