I use multiple-cursors and don't have a problem with it. Who cares whether it's efficient? I will prefer lsp-rename where possible, but if I'm replacing some strings or whatever it's very quick to just select the string, and then add a few cursors and change them all at once (I use s-d for that). It's not like I'm using thousands of cursors at once.

Someone posted a link in the comments pointing out that Emacs's internal representation of a buffer is not really designed to support multiple cursors efficiently. For batch changes in a large file, macros would be more suitable. I haven't really seen this be a problem in my workflow.