A Painful Setback: Misinterpretation of Analgesic Safety in Older Adults May Inadvertently Worsen Pain Care—Reply

In reply

We thank Hwang and colleagues for their interest in our work¹ and share with them a strong belief in the importance of adequate pain relief. The focus of our study was the comparative safety of analgesics, and thus the message should not be misconstrued as advocating inadequate pain relief. Many of the limitations that they point out are the usual arguments against observational drug studies. We agree that observational studies of comparative safety have limitations. However, if well designed and conducted with rigor, they can provide important evidence to inform prescribing decisions. We went to great lengths to limit the potential for confounding bias, but a nonexperimental design can never completely rule out such bias, and thus interpretation must be cautious. We are disappointed that they provide no evidence to support their implication that opioids and nonsteroidal anti-inflammatory drugs have a similar safety profile; our results suggest otherwise.