A widely used back-pain medication may come with a serious, previously under-recognized risk: a higher likelihood of developing dementia or cognitive decline. That’s the warning from a major new study examining gabapentin, a drug millions of Americans take for chronic low-back pain. For years, gabapentin has been prescribed as a supposedly safer alternative to opioids. But researchers are now raising questions about whether long-term use carries neurological consequences that patients and doctors should not ignore.
The study, led by Case Western Reserve University and conducted with data from 68 health systems across the U.S., compared more than 26,000 adults who received gabapentin for persistent back pain with a matched group experiencing the same pain levels but who never took the medication. The difference in outcomes was striking. Adults who had been prescribed gabapentin six times or more were 29 percent more likely to develop dementia within ten years, and 85 percent more likely to be diagnosed with mild cognitive impairment—an early warning sign of more serious decline.
What surprised researchers even more was how sharply the risks rose for younger adults. People aged 35 to 49 saw more than double the dementia risk of their counterparts who did not take gabapentin, and their likelihood of developing mild cognitive impairment more than tripled. Those between 50 and 64 also showed significantly heightened risk, despite being years away from the age group where dementia typically appears. Only the youngest adults in the study—those 18 to 34—showed no measurable increase, suggesting age interacts with gabapentin’s neurological effects in ways researchers do not yet fully understand.
The findings were published in Regional Anesthesia & Pain Medicine, and the authors made their concerns clear. They urged clinicians to monitor patients closely for signs of cognitive decline and to rethink the casual, long-term prescribing habits that have become common across the country. While gabapentin has long been viewed as relatively low-risk, the size and scope of this study indicate something far more complicated may be happening.
Like many medications, gabapentin brings side effects that patients often learn to tolerate—dizziness, fatigue, swelling from fluid retention, and dry mouth among them. Earlier research has also linked the drug to breathing problems in vulnerable populations. But the new data suggest that the more frequently a person is prescribed gabapentin, the steeper the neurological cost may become. People who received 12 or more prescriptions faced a 40 percent increased risk of dementia and a 65 percent greater likelihood of developing mild cognitive impairment. These patterns held even after accounting for other medications, existing medical conditions, and demographic factors.
Still, the researchers emphasize that correlation doesn’t prove causation. This was an observational study, not a controlled trial, which means the drug cannot be definitively blamed as the direct cause of cognitive decline. The team could not analyze exact dosage amounts or how consistently patients took the medication. They could only examine the long-term outcomes of people who received prescriptions. Even so, the sheer volume of medical records reviewed strengthens the argument that the association is meaningful and warrants further investigation.
Gabapentin was originally approved in the early 1990s as a treatment for epilepsy. Over time, doctors began prescribing it for a wide range of conditions: nerve pain, shingles pain, anxiety, restless legs syndrome, migraines, and—eventually—chronic back pain. As the opioid crisis deepened, gabapentin became a go-to alternative for physicians reluctant to use addictive painkillers. Prescriptions skyrocketed. Many patients ended up taking it for years, often with little follow-up, simply because it was considered safer than the alternatives.
In reality, chronic back-pain patients often struggle with mobility issues, which are already a known risk factor for dementia. But the researchers accounted for that too. They matched gabapentin users with patients experiencing similar levels of physical limitation—and the cognitive risks still showed up in those who took the drug. Reduced mobility didn’t explain the difference.
That leaves an uncomfortable truth: millions of Americans are taking a medication that may be quietly affecting their cognitive health over time. And because symptoms like forgetfulness, slowed thinking, or concentration problems can be dismissed as stress or aging, early warning signs may go unnoticed.
For patients, the message is not to panic—but to pay attention.
Experts recommend that anyone taking gabapentin, especially long term, should check in regularly with their doctor about memory, focus, or mental sharpness. Patients should never stop the medication abruptly—gabapentin withdrawal can be dangerous—but they can discuss alternative therapies, lower doses, or shorter treatment plans. In many cases, physical therapy, lifestyle changes, or other non-pharmaceutical interventions may be viable substitutes for chronic pain management.
Families should also be aware of potential mood or cognitive changes in loved ones using gabapentin. Early detection of mild impairment can make a significant difference in long-term outcomes, even if the exact cause remains uncertain.
Despite the new concerns, gabapentin still remains safer than many medications used for chronic pain and nerve disorders. But “safer” does not mean “risk-free,” and the study’s authors stress that its widespread use demands closer scrutiny. With more than 60 million prescriptions written annually in the U.S., even a modest risk could translate into hundreds of thousands of cases of preventable cognitive decline over time.
The study closes with a clear warning: long-term gabapentin use is strongly associated with later-life dementia and cognitive impairment. Given how many Americans depend on the medication, that association cannot be brushed aside. More research is needed, better awareness is essential, and patients deserve transparency about potential risks.
For now, one thing is certain—gabapentin may help ease pain, but it’s time to take its long-term effects far more seriously.