Long-term gabapentin use for pain management may increase the risk of dementia
A recent body of research has raised concerns about the long-term use of gabapentin for managing lower back pain, particularly in adults aged 35-49. The studies suggest that this drug, often prescribed off-label for various conditions, may significantly increase the risk of cognitive decline and dementia-like conditions.
Key findings from these studies, published in 2025, indicate that patients taking gabapentin for six months or more had a 29% higher risk of developing dementia and an 85% higher risk of developing mild cognitive impairment (MCI) compared to those not prescribed the drug. The risk is particularly elevated in middle-aged adults, where dementia risk more than doubled and MCI risk more than tripled for those aged 35-49.
Researchers caution that these are associative rather than confirmed causal relationships. The findings emerged from large dataset analyses, such as one study examining over 26,000 patients prescribed gabapentin for persistent low back pain and matched controls, tracked over a 10-year period.
Neel Anand, a board-certified orthopedic spine surgeon, points out the challenges in large dataset studies, including determining the true causative factor. He suggests a study design involving a cohort of participants who take a specific medication (gabapentin) and another who does not, to better understand the effects of long-term drug use.
Anand acknowledges the possibility of a heightened risk of dementia with prolonged gabapentin use, which should be addressed by doctors and counseled to patients. The researchers advise patients who are taking gabapentin to alert their physician if they notice any cognitive deficits, including confusion, poor memory, or slowed thinking.
Eghrari, another researcher, emphasizes the need for closer monitoring of patients prescribed gabapentin for chronic back pain. The study findings suggest a greater cognitive impact of gabapentin in non-elderly individuals, making it crucial to exercise caution in this age group.
Gabapentin is approved by the Food and Drug Administration (FDA) for the treatment of some epileptic seizures, moderate-to-severe restless legs syndrome, and postherpetic neuralgia. However, its off-label use for conditions such as anxiety disorders, insomnia, hot flashes, alcohol use disorder, akathisia, diabetic peripheral neuropathy, and lower back pain may carry unforeseen risks.
In light of these findings, physicians prescribing gabapentin for chronic pain management are recommended to perform regular cognitive exams on their patients. The risks associated with gabapentin use for lower back pain in middle-aged adults highlight the need for careful monitoring and consideration of risks when prescribing this drug.
- The long-term use of gabapentin, often prescribed off-label for various conditions, has been linked to a significantly increased risk of cognitive decline and dementia-like conditions in adults aged 35-49.
- Researchers have cautioned that while the current findings indicate associative relationships, prolonged use of gabapentin may pose a heightened risk of dementia and mild cognitive impairment (MCI).
- In light of these findings, physicians are recommended to perform regular cognitive exams on patients prescribed gabapentin for chronic pain management, especially for non-elderly individuals.
- The study findings suggest a greater cognitive impact of gabapentin in middle-aged adults, making it crucial for mental-health professionals to exercise caution when prescribing this drug for this age group in the field of health-and-wellness.
- While gabapentin is approved by the Food and Drug Administration (FDA) for certain conditions, its off-label use for a variety of conditions may carry unforeseen risks, particularly when it comes to neurological disorders such as dementia and neurological decline.
