Reply to Comment on Nakai, Y.; Makizako, H.; Kiyama, R.; Tomioka, K.; Taniguchi, Y.; Kubozono, T.; Takenaka, T.; Ohishi, M. Association between Chronic Pain and Physical Frailty in Community-Dwelling Older Adults. Int. J. Environ. Res. Public Health 2019, 16, 1330, doi:10.3390/ijerph16081330

Seven participants had a diagnosis of dementia; the number of excluded participants differed based on different exclusion processes, and there was missing data of one participant with a dementia diagnosis. That is, one participant was excluded in the missing data before being excluded by the dementia diagnosis. Certification for long-term care in Japan occurs at the disability level, not at the frailty level [1,2]. Therefore, in many Japanese cohort studies, certification for long-term care is an exclusion criterion [3]. Also, in this study, participants who were already certified for long-term care were excluded from the discussion of the frailty state. There can be multiple causes of chronic pain that cannot be identified in a single community-based cohort study [4]. Further, in the current study, we did not explore the use of painkillers and, thus far, no discussion has taken place in this regard [5]. This is an aspect we would like to consider in future studies.