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Is a bird in the hand still worth two in the bush?

A good understanding of peripheral and central nociceptive transmission mechanisms offers a variety of ways to manage acute pain efficiently. Pharmacological therapies range from monotherapy with commonly used analgesics, such as antiinflammatory agents, nonopioid analgesics, such as paracetamol, weak and strong opioids, local anaesthetics, N-methyl-D-aspartate blocking agents, and ion channel blockers, to any combination of these as multimodal therapy. In the present issue of the Journal, Rasmussen et al. provide an interesting example of what an analgesic cocktail might look like when the concept of multimodal analgesia in clinical practice is taken seriously. This begs the question as to whether such a cocktail is always advantageous or whether combining such diverse chemical substances constitutes an additional risk.