Background Pain is a major public health issue, and a common reason people seek medical care. Pharmacological treatments depend on the type of pain and carry different risks and benefits. The aim of this study was to examine trends in analgesic prescribing in Ireland and England between 2014 and 2022.

Methods Monthly data on medicines prescribed and dispensed in primary care were used. For Ireland, data on the means-tested General Medical Services (GMS) scheme were used, covering approximately 32% of the population. For England, data from the NHS Digital platform for all general practices were used. Outcomes were the volume of prescribed analgesic use, including rates of dispensings, costs, and standard doses (including oral morphine equivalents (OMEs) for opioids) per 1,000 population, summarised per year for each drug class/drug.

Results In Ireland, the rate of analgesia dispensings increased between 2014 and 2022 for most drugs. Opioid dispensings increased from 979 to 1,220 per 1,000 population, while paracetamol increased from 1,295 to 1,824. Systemic NSAIDs decreased from 781 to 734. In England, most analgesia dispensing rates decreased, with opioids decreasing from 721 to 585 per 1,000 population, paracetamol from 734 to 484, and systemic NSAIDs from 259 to 167.

Discussion Substantially different dispensing patterns were found in Ireland and England, with higher increasing overall rates in Ireland and lower decreasing rates in England, potentially driven by the older age and lower socioeconomic status of GMS patients in Ireland. Further research to understand drivers for this higher volume of use is required.

The authors have declared no competing interest.

This study is funded by the Health Research Board in Ireland (HRB) through the Secondary Data Analysis Projects scheme (CDRx project, PI FM, grant number SDAP-2019-023). The funder had no role in in study design; in the collection, analysis, and interpretation of data; in the writing of this paper; or in the decision to submit this paper for publication. EW is funded by a HRB Emerging Clinician Scientist Award (grant number: ECSA/2020/002). MEW is funded by a HRB Applying Research into Policy and Practice Award (ARPP/2020/004). OpenPrescribing.net is currently funded by NHS England Primary Care and Medicines Analytics Unit. All other Bennett funding information is available at https://www.bennett.ox.ac.uk/

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

RCSI University of Medicine and Health Sciences Research Ethics Committee (ref: REC202201015) of RCSI Dublin and the Health Service Executive (HSE) Reference Research Ethics Committee B (ref: RRECB1022FM) of the Health Service Exceutive gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Code and data for the analysis of NHS data will be available from github. Code for the analysis of GMS data will be available from zenodo. GMS data in aggregated form can be requested from the HSE PCRS at https://www.hse.ie/eng/staff/pcrs/pcrs-publications/.