Popular Pain Medication Linked to Higher Dementia Risk in New Study

Long-term gabapentin users face an 85% greater chance of cognitive decline, research finds

Millions of Americans who rely on gabapentin for chronic back pain may face an unexpected health risk: significantly higher chances of developing dementia and cognitive problems later in life.

A new study published in Regional Anesthesia & Pain Medicine found that people who receive six or more prescriptions of gabapentin for lower back pain are at a higher risk of developing dementia and mild cognitive impairment. The research, which tracked more than 26,000 patients over a 10-year period, revealed particularly alarming findings for younger adults.

The Numbers Paint a Concerning Picture

The study found that patients receiving six or more gabapentin prescriptions faced a 29% higher risk of developing dementia, and an 85% greater chance of being diagnosed with mild cognitive impairment compared to those not taking the medication long-term.

Even more striking, the risks for dementia more than doubled and more than tripled for mild cognitive impairment in people who were 35 to 49 years old. This finding surprised researchers, who expected elderly patients to show the highest risk given their naturally increased vulnerability to cognitive decline.

What Is Gabapentin?

Gabapentin, sold under brand names like Neurontin, was initially developed to treat epileptic seizures. The Food and Drug Administration approved it for some epileptic seizures, moderate-to-severe restless legs syndrome, and postherpetic neuralgia, which is a nerve pain associated with shingles.

However, doctors frequently prescribe it off-label for conditions beyond its original approval, including anxiety disorders, insomnia, hot flashes, alcohol use disorder, akathisia, diabetic peripheral neuropathy, and lower back pain. Off-label prescribing refers to the practice of doctors legally prescribing FDA-approved drugs for conditions other than those for which they were initially approved, based on their medical judgment and emerging research.

The medication has become increasingly popular for chronic pain management, particularly as healthcare providers seek alternatives to opioid painkillers amid the ongoing addiction crisis.

A Growing Concern

This isn't the first study to raise red flags about gabapentin's cognitive effects. Past studies have also found that using gabapentin may cause breathing difficulties, cognitive impairment, and dementia.

The new research adds weight to these concerns by demonstrating the association on a large scale. The study analyzed data from the TriNetX health research network, examining patients diagnosed with chronic pain conditions, including chronic pain syndrome, lumbar radiculopathy, and chronic low back pain.

What This Means for Patients

The researchers emphasize that their findings show an association, not definitive proof that gabapentin causes dementia. However, the results are significant enough to warrant changes in how doctors and patients approach the use of this medication.

The Bigger Picture

The study highlights a common challenge in modern medicine: weighing the benefits of pain relief against potential long-term risks. For many patients, gabapentin provides significant improvement in quality of life by managing chronic pain that might otherwise be debilitating.

However, the findings suggest that both doctors and patients need to have more thorough discussions about long-term use, particularly for younger adults who showed the highest risk increases. The research team described the elevated risk in non-elderly patients as unexpected, since elderly individuals are already at higher baseline risk for cognitive decline due to age.

Study Limitations and Future Research

Medical experts note that large-scale studies like this one face inherent challenges. The research provides limited information about participants' other health conditions or medications they might have been taking concurrently, factors that could influence cognitive outcomes.

The most definitive way to establish causation would require controlled studies comparing groups taking only gabapentin against those taking no medication over several years, ensuring strict adherence to treatment protocols.

The research team plans to continue investigating whether gabapentin directly causes cognitive decline or if other factors might explain the association. They also want to understand the biological mechanisms that might link the medication to brain changes.

Looking Ahead

For now, the study serves as an important reminder that even commonly prescribed medications can have unexpected long-term consequences. Patients currently taking gabapentin shouldn't stop their medication without consulting their doctors, but they should discuss the findings and whether cognitive monitoring might be appropriate.

The research also underscores the importance of exploring all pain management options, including non-pharmaceutical approaches, before committing to long-term medication use. 

Healthcare providers may need to reconsider the risk-benefit calculation for gabapentin, particularly for younger patients facing decades of potential treatment.

As the medical community continues to seek effective pain management strategies that minimize long-term risks, this research adds another piece to the complex puzzle of balancing immediate relief with future health outcomes.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare provider before making any decisions about medication use, including starting, stopping, or changing treatments. Do not discontinue any prescribed medication without first discussing it with your doctor.

About the authors

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Dementia, Alzheimer's by Steven HWG is licensed under Unsplash unsplash.com
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