A medication commonly prescribed for chronic back pain is now drawing growing attention from researchers after a major new study suggested it may be associated with an increased risk of dementia and cognitive decline.

The drug, gabapentin, has been used for decades and is often considered a safer alternative to opioid painkillers. Millions of people take it for nerve pain, chronic back pain, restless legs syndrome, and other long-term conditions.

But according to new findings from researchers at Case Western Reserve University and collaborating institutions, long-term use may come with cognitive risks that patients and doctors should carefully consider.

🔬 Researchers Compared More Than 26,000 Adults

The research team analyzed medical records from 68 health systems across the United States.

They compared:

• 26,414 adults who were prescribed gabapentin for chronic low-back pain
• with a matched group of adults who had similar pain conditions but did not take the medication.

The researchers then followed patients for up to 10 years to evaluate rates of dementia and mild cognitive impairment (MCI).

📈 The Results Raised Concern

The findings showed a significant association between repeated gabapentin prescriptions and later cognitive decline.

Adults who received six or more gabapentin prescriptions were:

• 29% more likely to develop dementia
• 85% more likely to develop mild cognitive impairment (MCI)

Mild cognitive impairment refers to noticeable memory or thinking problems that are greater than normal aging but not severe enough to interfere heavily with daily life.

Researchers noted that MCI can sometimes progress to dementia over time.

⚠️ Younger Adults Showed Surprisingly High Risk

One of the most unexpected findings involved middle-aged adults rather than seniors.

Among adults ages 35–49:

• dementia risk more than doubled,
• and MCI risk more than tripled.

Adults ages 50–64 also showed elevated risk levels.

Interestingly, researchers did not observe increased dementia risk among adults aged 18–34.

💊 More Prescriptions Appeared to Increase Risk

The study found what researchers described as a “dose-response relationship.”

In simple terms, people who received more prescriptions appeared to face greater cognitive risk.

Among adults with 12 or more prescriptions:

• dementia risk increased by 40%,
• and MCI risk increased by 65%.

The pattern remained even after researchers adjusted for:

• age,
• other medical conditions,
• medication use,
• and demographic factors.

🧠 What Is Gabapentin?

Gabapentin was originally approved in the 1990s as a treatment for epilepsy.

Over time, doctors increasingly prescribed it for:

• nerve pain,
• chronic back pain,
• post-shingles pain,
• fibromyalgia,
• and restless legs syndrome.

Because it is not an opioid, gabapentin became especially popular during efforts to reduce opioid prescribing.

Many patients take the drug for months or even years.

🩺 Common Side Effects Already Associated With Gabapentin

Like many medications affecting the nervous system, gabapentin already carries known side effects.

Commonly Reported Effects Include:

• drowsiness,
• dizziness,
• fatigue,
• swelling in the limbs,
• dry mouth,
• difficulty concentrating.

Earlier research has also raised concerns about breathing problems in some patients, especially when combined with other sedating medications.

The explanation of whether gabapentin directly causes dementia—and what patients should do next—continues on the next page.