We thank Drs Krishnamoorthy and Bhalla for their comments and encouragement. One of the major limitations of our population-based study is the lack of clinical information regarding pain associated with procedures. Unfortunately, we cannot comment on the amount of pain that the patients we studied experienced, only on their use of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs).1
Alam A, Gomes T, Bell CM. Long-term Analgesic Use: Sometimes Less Is Not More—Reply. Arch Intern Med. 2012;172(15):1189–1190. doi:10.1001/archinternmed.2012.2897
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