Every day, millions of Americans take a commonly prescribed medication to manage chronic back pain — often without a second thought. For many, it has become a long-term part of their daily routine, considered a safer and more manageable option compared to stronger pain relievers. But a significant new study is raising important questions about whether extended use of this drug may be associated with a higher risk of cognitive decline, including dementia.
The medication in question is gabapentin — and while it remains widely used and generally considered safe, researchers are now urging both patients and healthcare providers to take a closer look at its long-term effects on the brain.
What the Study Found
The research, conducted by scientists at Case Western Reserve University in collaboration with several partner institutions, represents one of the largest analyses of gabapentin’s cognitive effects to date. The team reviewed medical records drawn from 68 health systems across the United States, examining data from 26,414 adults who had been prescribed gabapentin for persistent lower back pain.
To ensure a fair comparison, researchers matched these individuals with a group of adults who had similar levels of back pain but had not been prescribed the drug. The results, published in the journal Regional Anesthesia & Pain Medicine, revealed a striking pattern.
Adults who received six or more gabapentin prescriptions were found to be 29% more likely to receive a dementia diagnosis within a 10-year period. More notably, they were 85% more likely to develop mild cognitive impairment (MCI) — a condition characterized by noticeable but not yet severe changes in memory and thinking that can often be an early indicator of dementia.
These are significant numbers, and researchers were transparent about their implications. Their published conclusion called for “close monitoring of adult patients prescribed gabapentin to assess for potential cognitive decline.”
Younger Adults Face Surprisingly High Risks
One of the most unexpected findings of the study was that the elevated risk was not limited to older adults — the age group most commonly associated with dementia. In fact, the data suggested that middle-aged adults may face some of the most dramatic increases in cognitive risk.
Among adults between the ages of 35 and 49 who were taking gabapentin, the risk of developing dementia was more than double that of their peers who weren’t taking the medication. Even more striking, their risk of developing mild cognitive impairment was found to be more than three times higher.
Adults between the ages of 50 and 64 also showed significantly elevated risks across both categories. Only the youngest group studied — those between 18 and 34 — showed no meaningful increase in cognitive risk.
This finding challenges the common assumption that cognitive decline is primarily a concern for people in their 70s and beyond. The data suggests that if a link between gabapentin and cognitive health does exist, it may be most relevant for working-age adults who take the medication over long periods.
The More Prescriptions, the Higher the Risk
The study also revealed what researchers describe as a dose-response pattern — meaning that the more gabapentin a person was prescribed, the stronger the association with cognitive decline.
Among participants who received 12 or more prescriptions, the risk of developing dementia rose to 40% higher than the comparison group, while the risk of mild cognitive impairment climbed to 65% higher. These elevated risks persisted even after researchers accounted for other variables including existing health conditions, demographic differences, and other medications the participants may have been taking.
This pattern adds weight to the concern, as it suggests the association isn’t simply a coincidence or a reflection of pre-existing health issues.
Does Gabapentin Actually Cause Dementia?
This is the critical question, and the researchers are careful to be clear: this study does not prove that gabapentin directly causes dementia.
The research was observational in nature, which means it identifies a statistical association between gabapentin use and cognitive outcomes — not a definitive causal relationship. There are important limitations to acknowledge. The study was unable to analyze specific dosage levels or the exact duration of use for individual participants. Additionally, other factors that weren’t captured in the data could potentially influence the results.
However, the size of the dataset is significant. Analyzing records from tens of thousands of patients across dozens of health systems provides a broad and diverse picture, and the consistency of the findings across different age groups and prescription levels is difficult to dismiss.
The researchers themselves noted that the findings “indicate an association between gabapentin prescription and dementia or cognitive impairment within 10 years” — and given how widely the drug is used, they argue that this warrants serious attention from the medical community.
Understanding Why Gabapentin Is So Widely Prescribed
To appreciate the significance of this study, it helps to understand just how prevalent gabapentin use has become in the United States. Originally developed in the early 1990s and approved by the FDA primarily to treat epilepsy, gabapentin has since been embraced by physicians across a wide range of specialties as a go-to option for chronic pain management.
It is commonly prescribed for nerve-related pain conditions, post-shingles discomfort, restless legs syndrome, and — most relevantly — chronic lower back pain. Its popularity surged in part as a response to the opioid crisis. As doctors and regulators worked to reduce reliance on opioid-based pain medications, gabapentin emerged as a widely accepted alternative, viewed as carrying fewer serious risks.
Today, it is one of the most frequently prescribed medications in the country, with tens of millions of prescriptions written annually. Many patients take it continuously over months or even years to manage ongoing pain — exactly the pattern that the new study found to be most closely linked with elevated cognitive risk.
An Important Clarification About Mobility
One factor the researchers were particularly mindful of was the role of physical mobility. It is already well established in medical literature that limited mobility and a sedentary lifestyle can increase a person’s risk of cognitive decline. Since many people taking gabapentin for back pain may also have limited mobility due to their condition, one might assume that reduced physical activity — rather than the medication itself — could explain the cognitive findings.
The researchers addressed this directly by ensuring that the comparison group also consisted of individuals with similarly restricted mobility due to their back pain. Despite this careful matching, gabapentin users still showed significantly higher rates of cognitive decline — suggesting that mobility limitations alone do not account for the difference.
What Patients and Caregivers Should Know
The most important message from this research is not one of alarm, but of awareness. Gabapentin continues to be approved for use and is considered appropriate for many patients when prescribed and monitored correctly. Abruptly stopping the medication without medical guidance is not advisable and can cause withdrawal symptoms.
However, the study does reinforce several recommendations that experts say are worth taking seriously:
Talk to your doctor. If you or someone you care for has been on gabapentin for an extended period — particularly with six or more prescriptions — it may be worth having a conversation with your healthcare provider about the latest research and whether the current treatment plan remains the most appropriate one.
Consider cognitive check-ins. Particularly for middle-aged adults on long-term gabapentin therapy, proactive monitoring of cognitive health could allow for earlier detection of any changes in memory or thinking.
Explore alternatives. For patients whose conditions allow it, discussing alternative approaches to pain management — whether physical therapy, other medications, or lifestyle changes — may be worth exploring in light of these findings.
Avoid unnecessary long-term use. Where clinically appropriate, healthcare providers may want to reassess whether continued long-term gabapentin use is necessary for each individual patient.
A Growing Body of Concern
This latest study is part of a broader and evolving conversation about gabapentin’s side effect profile. Earlier research has already raised concerns about the medication’s potential effects on breathing, particularly in individuals with respiratory conditions or when combined with other substances that affect the central nervous system. Other commonly reported side effects include dizziness, unusual fatigue, swelling, and dry mouth.
These concerns do not mean the medication is dangerous for everyone, but they do suggest that — like all medications — gabapentin comes with a risk-benefit calculation that deserves ongoing scrutiny.
The Bottom Line
Gabapentin has provided meaningful relief for millions of people living with chronic pain, and that should not be minimized. For many patients, it remains a valuable tool in managing conditions that can significantly diminish quality of life.
But the findings from this large-scale study add an important layer of complexity to the conversation. The potential link between long-term gabapentin use and cognitive decline — particularly among adults in their 30s, 40s, and 50s — is a development that both patients and healthcare providers deserve to be informed about.
As the researchers put it, their results support the need for careful, ongoing monitoring of patients on gabapentin therapy. In a country where the drug is prescribed to tens of millions of people each year, that message carries real weight.
If you are currently taking gabapentin, the best step you can take is to stay informed and maintain an open, ongoing dialogue with your doctor about your long-term treatment options.
