Common Back-Pain Drug May Be Linked to Higher Dementia Risk, Large Study Finds

 

Common Back‑Pain Drug May Be Linked to Higher Dementia Risk, Large Study Finds

Key Point: A large new study has found that gabapentin, a widely prescribed medication for chronic low back pain and nerve pain, is associated with significantly increased risks of dementia and mild cognitive impairment (MCI) — especially among younger adults under 65. 

Background: Why This Matters

Gabapentin is a prescription medication originally developed and approved in the 1990s to treat seizures. Over time, doctors started prescribing it “off‑label” for chronic pain conditions, especially nerve‑related back pain, because it’s generally considered safer than stronger painkillers such as opioids. 

Unlike opioids — which carry a well‑known risk of addiction and respiratory depression — gabapentin has grown in popularity due to its lower abuse potential and perceived safety. In fact, millions of adults with chronic back pain take gabapentin regularly.

However, until now, there has been limited large‑scale research on gabapentin’s long‑term effects on the brain — particularly its relationship with cognitive decline and dementia. That gap is what prompted the new study. 

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The Big Study: What Researchers Did

The research, published in the peer‑reviewed journal Regional Anesthesia & Pain Medicine, is one of the largest studies to date examining the cognitive outcomes of adults prescribed gabapentin for chronic low back pain. 

Study Design

• Data Source: The scientists used the TriNetX national database, containing electronic health records from 68 U.S. healthcare organizations.Participants: More than 52,000 adults diagnosed with chronic low back pain between 2004 and 2024. 

• Groups Compared:

  • Gabapentin users: 26,416 adults prescribed gabapentin six or more times. 

  • Matched controls: 26,416 similar adults who did not receive gabapentin. 

To make fair comparisons, researchers used a technique called propensity score matching, which helps balance patients by age, sex, other medical conditions, and other pain medications so that the groups looked similar except for gabapentin use. 

Tracking Over Time

Patients were followed for up to 10 years after their first back pain diagnosis to see whether they later developed:

• Dementia

• Mild Cognitive Impairment (MCI)

These diagnoses are serious: dementia can deeply affect memory, language, judgment, and independence, while MCI often precedes dementia. 

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Major Findings: Increased Risk of Dementia and Cognitive Decline

1. Higher Risk Overall

Compared with back pain patients who did not take gabapentin:

• Those with six or more gabapentin prescriptions had a 29% higher risk of being diagnosed with dementia within 10 years.

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This suggests a strong association between sustained gabapentin use and future cognitive health problems — though it’s important to note that association does not prove causation. 

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2. Younger Adults Show Strongest Increases

One of the most surprising and concerning aspects of the study was that the greatest relative risks appeared in younger adults (ages 18–64) — a group not typically considered at high risk for dementia.

In this non‑elderly group:

• Gabapentin users were more than twice as likely to develop dementia as non‑users. 

• They were similarly more than twice as likely to develop MCI. 

When broken down further:

• Among those aged 35–49, risks more than doubled for dementia and more than tripled for MCI.Among adults aged 50–64, similar elevated risks were observed. 

In contrast, adults aged 65 and older also showed increased risk, but the relative difference was smaller because older adults already have a higher baseline dementia risk. 

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3. More Prescriptions = Higher Risk

The study also found what’s known as a dose‑response relationship:

• People with 12 or more gabapentin prescriptions had a higher rate of dementia and cognitive impairment than those who received 3–11 prescriptions. 

This pattern strengthens the idea that the amount of exposure matters, though again, because this research is observational, we cannot say for sure that gabapentin directly caused the cognitive decline. 

What This Means: Interpreting the Results

Association vs Causation

The study’s authors and experts repeatedly emphasize that this research cannot definitively prove that gabapentin causes dementia — only that there is a statistical association between gabapentin use and a higher incidence of cognitive decline. 

Observational studies like this are vulnerable to other unmeasured factors that might influence results — such as:

• The severity of the underlying pain condition

• Lifestyle factors like physical activity, sleep, or diet

• Other medications not captured or controlled

• Pain itself potentially contributing to brain changes

Future randomized controlled trials or laboratory research would be needed to clarify causality and understand biological mechanisms. 

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Possible Biological Explanations (Still Theorized)

Because gabapentin affects how nerve cells communicate in the brain, some scientists hypothesize that long‑term use might interfere with normal neural signaling or plasticity, which is vital for memory and learning. 

Additionally, gabapentin’s side effects — such as sedation, dizziness, and “brain fog” — suggest it can affect cognitive function even in the short term. But whether those effects can accumulate into long‑term neurodegeneration remains unknown and controversial. 

Clinical and Practical Implications

For Physicians

Medical professionals are being urged to:

• Discuss potential risks and benefits carefully with patients before starting long‑term gabapentin therapy. 

• Monitor cognitive function periodically, especially in patients with repeated prescriptions. 

• Consider alternative pain management strategies where appropriate.

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For Patients

Patients currently taking gabapentin — especially for long durations — may want to:

• Talk with their healthcare provider about their individual risk profile.

• Be attentive to any memory changes or cognitive difficulties.

• Avoid abruptly stopping gabapentin without medical guidance, as it should be tapered to prevent withdrawal symptoms. 

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Expert and Researcher Reactions

While some clinicians were surprised by the strong association in younger adults, many emphasize that gabapentin has important uses — especially when other pain treatments are not effective or suitable. 

Researchers also stress the importance of not over‑interpreting the study — calling it a signal that warrants further investigation, not definitive evidence that gabapentin causes dementia. 

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What’s Next in Research

Important areas for future research include:

• Understanding the biological mechanism: How might gabapentin affect brain cells over time?

• Clarifying causation: Can gabapentin itself trigger neurodegeneration, or is the association due to related factors?

• Comparing different pain treatments: Do other medications carry similar or lesser risks?

• Exploring dosage and duration effects: Is there a safe threshold of use?

Such studies could help doctors make more precise recommendations tailored to individual risk. 

Conclusion: What Should People Take Away?

The new study linking gabapentin to increased dementia risk is significant because:

• It is one of the largest studies examining this question. It shows a clear statistical association between frequent gabapentin prescriptions and later cognitive problems. 

• The association is especially strong in adults under 65, a group not usually considered at high dementia risk. 

• Because the study is observational, it cannot prove causation, but it signals a need for caution and further research.