Gabapentin May Raise Dementia Risk – Especially in Middle Age

Gabapentin is often seen as a safer option for treating chronic pain, but new research suggests it may come with cognitive risks.

A large study using US electronic health records, published in Regional Anesthesia & Pain Medicine, found that adults prescribed gabapentin for low back pain were more likely to develop dementia or mild cognitive impairment.

Is gabapentin safe for long-term use in treating back pain?

Chronic low back pain affects millions and puts pressure on healthcare systems worldwide, and treating it isn’t simple. Opioids used to be the go-to option; however, their high risk of dependence and overdose has pushed doctors to look elsewhere.

Originally developed for epilepsy, gabapentin is now widely prescribed for chronic pain, especially nerve-related pain. Its appeal lies in its low potential for addiction. Some researchers have also suggested it might protect the brain, although concerns are growing.

There are signs that gabapentin might not be as safe as once thought – at least not for long-term use. Reports have linked it to memory problems and signs of brain aging.

“Gabapentin is widely used to treat chronic pain, but its association with cognitive decline and dementia remains unclear,” said the authors of the recent study.

Previous research has been inconsistent: some studies show a link to cognitive decline, whereas others do not. It’s also unclear whether certain age groups are more affected than others.

Now, a large new study has added weight to those concerns.

The investigation set out to test the association using real-world medical records, with a focus on how age and prescription frequency might influence risk.

Study finds increased dementia risk with gabapentin use

The team used data from TriNetX, a large US database of electronic health records covering 68 healthcare organizations. They looked at 52,828 adults diagnosed with chronic low back pain, half of whom had been prescribed gabapentin and the other half – matched by age, sex, existing conditions and other medications – had not.

They tracked the patients over 10 years to see who developed dementia or mild cognitive impairment (MCI). The analysis controlled for other painkillers and pre-existing health issues.

The patients who were prescribed gabapentin 6 times or more were 29% more likely to develop dementia and 85% more likely to develop MCI than those who hadn’t taken the drug.

However, age also made a difference. Among 18–64-year-olds, the risk of either diagnosis more than doubled compared to non-users. Within that group, the biggest jump was in people aged 35–49 years, who had more than twice the risk of dementia and more than 3 times the risk of MCI. A similar pattern was observed in those aged 50–64 years.

No added risk was seen in patients aged 18 to 34 years.

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There was also a dose-response trend, with people who’d had 12 or more prescriptions being 40% more likely to develop dementia, and 65% more likely to develop MCI, than those with 3–11 prescriptions.

What does this mean for gabapentin and dementia research?

These results raise doubts about the long-term safety of gabapentin as a treatment for chronic pain. While it's often viewed as a safer alternative to opioids, this study suggests it may carry its own risks.

“Our findings indicate an association between gabapentin prescription and dementia or cognitive impairment within 10 years. Moreover, increased gabapentin prescription frequency correlated with dementia incidence,” said the team. “Our results support the need for close monitoring of adult patients prescribed gabapentin to assess for potential cognitive decline.”

However, the results do not mean that gabapentin directly causes dementia. The study doesn’t show cause and effect, nor does it include information on dose or treatment length.

As the study was retrospective, it’s also possible that early cognitive symptoms led to gabapentin use rather than the reverse.

There’s a clear need for further research, and prospective studies could help confirm if the link is real. Researchers also need to explore how dosage and duration affect outcomes and how gabapentin might influence the brain over time.

Reference: Eghrari NB, Yazji IH, Yavari B, Acker GMV, Kim CH. Risk of dementia following gabapentin prescription in chronic low back pain patients. Reg Anesth Pain Med. 2025. doi: 10.1136/rapm-2025-106577

This article is a rework of a press release issued by BMJ Group. Material has been edited for length and content.