A medication commonly prescribed for chronic back pain may carry a potential risk that many patients have never been warned about. According to a large new analysis drawing from tens of thousands of medical records, adults taking gabapentin for persistent low-back pain had significantly higher rates of later cognitive decline, including dementia and mild cognitive impairment (MCI).
The study does not prove that gabapentin directly causes dementia, but the scale of the data and the consistency of the association have drawn serious attention from researchers, clinicians, and public-health experts.
What the researchers examined
The findings come from scientists at Case Western Reserve University and several collaborating institutions. The team used data from 68 health systems across the United States, giving them access to millions of patient records and allowing for a detailed comparison between different types of back-pain patients.
From within these records, researchers identified 26,414 adults who were prescribed gabapentin for chronic low-back pain. They were then matched with another group of adults who reported similar levels of back pain and similar health profiles — but did not take gabapentin.
By comparing these two matched groups over a 10-year period, the researchers were able to estimate the long-term risks linked to gabapentin prescriptions.
Higher rates of dementia and cognitive decline
The overall finding was clear: gabapentin users showed increased risk of both dementia and mild cognitive impairment compared to non-users with similar medical backgrounds.
According to the published results:
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Adults who received six or more gabapentin prescriptions were 29% more likely to be diagnosed with dementia during the following decade.
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Their risk of developing MCI — a condition involving noticeable memory and thinking difficulties that may precede dementia — was 85% higher.
What stood out even more was how sharply the risks increased for younger adults. Dementia is typically associated with aging, yet the study found that middle-aged adults using gabapentin experienced some of the highest increases in risk.
Younger adults showed the steepest rises in risk
When researchers broke the results down by age, a concerning pattern emerged:
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Adults 35 to 49 taking gabapentin were more than twice as likely to develop dementia compared with peers not using the medication.
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Their risk of developing MCI was over three times higher.
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Adults aged 50 to 64 also saw significantly higher risk levels.
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The only group that did not show increased risk was adults aged 18 to 34.
While dementia in younger people remains rare, the relative changes observed in this study raised questions about how gabapentin might influence cognitive pathways at earlier stages of life.
The findings were published in the journal Regional Anesthesia & Pain Medicine, where the authors wrote that the data “support the need for close monitoring of adult patients prescribed gabapentin to assess for potential cognitive decline.”
The pattern was dose-related: more prescriptions, higher risk
Gabapentin is known to cause certain side effects, including dizziness, fatigue, swelling due to fluid retention, and dry mouth. Previous studies have also examined potential respiratory effects.
However, the new analysis revealed a clear dose-response pattern: the more often a person was prescribed gabapentin, the higher their cognitive risk appeared to be.
According to the researchers:
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Adults with 12 or more gabapentin prescriptions were 40% more likely to eventually develop dementia.
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Their likelihood of developing MCI was 65% higher.
These results held true even after adjusting for:
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age
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mobility limitations
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other medical conditions
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co-prescribed medications
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socioeconomic factors
This consistency strengthens the possibility that something about gabapentin itself — or the long-term conditions prompting its use — may play a role in cognitive changes.
Does this mean gabapentin causes dementia?
Not necessarily. The researchers emphasized that the study was observational. That means:
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It shows correlation but cannot prove causation.
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It identifies strong patterns, but cannot confirm the underlying biological mechanisms.
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It does not account for every possible factor affecting patient health.
The researchers were also unable to analyze specific dosages or exact duration of use because the prescription data did not include milligrams per day.
Even so, the large dataset — one of the most comprehensive collections of U.S. electronic health records — makes the findings difficult to dismiss. The patterns align with growing academic interest in whether long-term use of certain neurological medications could influence cognition.
Why gabapentin is prescribed so widely
Gabapentin first entered the market in the early 1990s as a medication for epilepsy. Over time, its use expanded dramatically. Today, it is frequently prescribed for:
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chronic back pain
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nerve pain
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post-shingles discomfort
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restless legs syndrome
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certain anxiety-related symptoms
Its rise in popularity is partly due to the ongoing opioid crisis. With physicians under pressure to limit opioid prescriptions, gabapentin became a common alternative for long-term pain management.
However, experts note that chronic pain itself often overlaps with limited mobility — which is already a known risk factor for cognitive decline. To address this concern, the research team matched gabapentin users with non-users who had comparable mobility limitations. That means mobility issues alone are unlikely to explain the heightened dementia risk.
What this means for patients and families
For people currently taking gabapentin, the study does not suggest stopping medication abruptly. Gabapentin should never be discontinued without medical supervision because sudden withdrawal can cause serious health reactions.
Instead, the main takeaway is awareness. Medical decisions should be informed, balanced, and collaborative.
Experts highlight several steps for patients and caregivers:
1. Schedule regular cognitive check-ins
Simple memory-screening questions or routine conversations about changes in concentration can help detect early concerns.
2. Discuss risks and benefits with a healthcare professional
Doctors can explain whether gabapentin remains the safest option or whether other treatments may be appropriate.
3. Review long-term necessity
Some patients may take gabapentin for many years without periodic reassessment. For chronic pain, revisiting the plan can be helpful.
4. Consider non-drug pain management options
Depending on the type of back pain, physical therapy, exercise programs, sleep improvement, stress reduction, and lifestyle adjustments may provide relief alongside or instead of medication.
Gabapentin remains a widely used and generally well-tolerated medication. But as with many long-term treatments, continued research and careful monitoring are essential.
Why these findings matter
Millions of Americans rely on gabapentin each year. Even a modest increase in dementia risk could have significant public-health implications simply because the medication is so common.
The authors of the study summarize their conclusion clearly: there is a measurable association between gabapentin prescriptions and later diagnosis of dementia or cognitive impairment over the following decade.
The study does not call for discontinuing gabapentin — but it does call for closer oversight, especially for adults who take the medication for many years.
As research continues, patients, caregivers, and clinicians may all benefit from greater attention to how pain treatments affect long-term brain health.
Sources
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Regional Anesthesia & Pain Medicine – Summary of the published study from Case Western Reserve University
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Case Western Reserve University School of Medicine – Research statements on gabapentin and cognitive outcomes
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National Institute on Aging – Background information on dementia and mild cognitive impairment
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U.S. Food and Drug Administration (FDA) – Safety profile and approved uses of gabapentin