Study Links Gabapentin Use to Higher Dementia Risk in Chronic Back Pain Patients

A major new study has found that gabapentin, a widely prescribed drug for chronic pain, may increase the risk of dementia and mild cognitive impairment in adults with chronic low back pain. The research, published in Regional Anesthesia and Pain Medicine, shows the risk is particularly elevated for non-elderly patients and increases with prescription frequency.

Researchers analyzed medical records from more than 26,000 adults using the TriNetX national healthcare database, focusing on patients with chronic low back pain. Individuals with prior dementia, epilepsy, stroke, cancer, or previous gabapentin use were excluded. After applying strict statistical matching methods, the study found that patients with six or more gabapentin prescriptions were significantly more likely to develop dementia and cognitive decline.

Among the key findings:

• Patients with six or more gabapentin prescriptions had a 29% increased risk of dementia (RR: 1.29; 95% CI: 1.18–1.40).
• The same group had an 85% higher risk of mild cognitive impairment (RR: 1.85; 95% CI: 1.63–2.10).
• Non-elderly adults aged 18–64 had more than twice the risk of dementia (RR: 2.10; 95% CI: 1.75–2.51) and MCI (RR: 2.50; 95% CI: 2.04–3.05) compared to those not on gabapentin.
• Patients prescribed gabapentin 12 or more times had a 40% greater risk of dementia and 65% higher risk of MCI than those with fewer prescriptions.

The findings add to a growing body of literature examining the long-term neurological safety of gabapentin. First approved in 1993 for seizure treatment, gabapentin later became widely used for chronic pain due to its perceived safety and low addiction risk. However, recent studies have raised questions about its effects on the brain, especially in younger populations.

Gabapentin works by inhibiting excitatory neurotransmitter release in the brain, altering pain signaling. Though some studies have suggested neuroprotective benefits, others have reported associations with cognitive decline, particularly in patients with coexisting respiratory or neurological conditions.

This latest analysis stands out for its scale and focus on age-stratified risk. It used de-identified data from 68 healthcare institutions across the U.S., spanning 20 years from 2004 to 2024. Researchers followed observational reporting guidelines and employed robust statistical matching to limit bias across age groups and comorbidities.

While causality cannot be definitively established from observational data, the authors emphasize the clinical importance of monitoring cognitive function in patients prescribed gabapentin—especially younger adults and those on long-term regimens.

The study does not call for ending the use of gabapentin but urges more informed prescribing and further research into its long-term neurological effects.

Editor’s Note: This article is based on findings published in the journal Regional Anesthesia and Pain Medicine. The original study can be accessed at dx.doi.org/10.1136/rapm-2025-106577. Virginia Times does not provide medical or clinical advice. Readers are encouraged to consult qualified healthcare professionals for personal medical decisions.