A medication commonly prescribed for chronic back pain may come with a lesser-known and potentially serious risk. A major new analysis suggests that long-term gabapentin use could be associated with an increased likelihood of developing dementia or early cognitive decline.
The study — conducted by researchers at Case Western Reserve University along with several collaborating institutions — examined health data from 68 U.S. medical systems. More than 26,000 adults who had been prescribed gabapentin for long-lasting lower-back pain were compared with a similar group of patients who had the same condition but did not take the drug.
The results raised concern among the research team. Adults who received six or more gabapentin prescriptions showed a 29% higher chance of being diagnosed with dementia within the following decade. Their risk of developing mild cognitive impairment (MCI) — often considered an early warning sign — was 85% higher.
What surprised researchers most was that the trend wasn’t limited to older adults. In fact, some of the strongest associations were seen in middle-aged patients. Gabapentin users ages 35 to 49 had more than double the risk of dementia and over triple the risk of MCI compared to non-users with the same condition. Adults ages 50 to 64 experienced similarly elevated rates. Only young adults between 18 and 34 appeared unaffected.
The findings, published in Regional Anesthesia & Pain Medicine, prompted a clear caution from the authors: people who rely on gabapentin should be monitored for signs of memory changes or cognitive difficulty over time.
Gabapentin has long had a known list of side effects — dizziness, fatigue, swelling, and dry mouth among them — and earlier studies have noted possible breathing complications. The new research suggests a possible long-term cognitive concern as well. The link grew stronger with heavier use: patients with 12 or more prescriptions were 40% more likely to receive a dementia diagnosis and 65% more likely to be diagnosed with MCI.
Importantly, the researchers noted that their study was observational. It identifies an association, not proof that gabapentin directly causes dementia. They also did not have detailed information about exact dosage levels or how consistently patients took the medication. Still, the size of the dataset and the consistency of the results across age groups suggest that the pattern merits closer attention.
Gabapentin has become widely used since its approval in the early 1990s. Originally developed to treat epilepsy, it is now a standard prescription for chronic nerve pain, persistent back pain, shingles complications, and restless legs syndrome. Many clinicians turn to it as a perceived safer alternative to long-term opioid therapy.
The researchers acknowledged that people using gabapentin for back pain often have mobility limitations — a factor already linked to cognitive decline. However, because gabapentin users were carefully matched with non-users facing similar mobility issues, the researchers believe this alone does not explain the differences in dementia rates.
Experts stress that the study’s findings should be viewed as a prompt for awareness, not alarm. They recommend:
Regular cognitive check-ins for long-term gabapentin users
Discussing treatment plans and medication duration with a healthcare professional
Exploring alternative pain-management strategies when medically appropriate
Gabapentin is still considered safer than many other pain-relief options, but like any medication, it carries potential risks that patients and physicians should understand.
For the millions of people who rely on it daily, the study raises important questions — and highlights the need to balance immediate pain relief with long-term cognitive health.