Gabapentin, an FDA-approved anticonvulsant commonly prescribed for nerve pain and seizures, is also widely used “off-label” for conditions such as fibromyalgia, sciatica, insomnia, anxiety, hot flashes, and chronic back pain. Its popularity stems from being considered a safer alternative to opioids. However, new research suggests extended use of the drug could carry cognitive risks.

Study Overview

A large-scale analysis published in Regional Anesthesia & Pain Medicine examined health data from more than 26,000 adults diagnosed with chronic pain, chronic pain syndrome, chronic lower back pain, or lumbar radiculopathy. This data was compared with an equally sized group not taking gabapentin. Participants were further divided into age groups (18–34, 35–49, 50–64, and 65+), and outcomes were tracked over a decade to assess the incidence of mild cognitive impairment (MCI), Alzheimer’s disease, or vascular dementia.

The findings revealed that patients with six or more gabapentin prescriptions faced a 29% increased risk of dementia and an 85% higher risk of developing MCI compared to non-users.

Age Groups at Highest Risk

Notably, the study found the strongest associations in younger adults. Among those aged 35–49, the risk of dementia was nearly double, and the risk of MCI was triple, compared to peers who did not use the drug. This was surprising, as dementia is generally associated with individuals over 65.

Lead researcher Nafis B. Eghrari, a medical student at Case Western Reserve University, explained that while the study does not prove causation, the results underscore the importance of further research into gabapentin’s long-term effects on brain health.

Limitations and Criticisms

As an observational study, several limitations must be acknowledged. Researchers did not control for other health conditions, concurrent medications, or lifestyle factors such as physical activity—an important protective factor against dementia. Experts also cautioned that variables like dosage and duration of treatment were not adequately accounted for.

Some specialists argue that other studies have found no such link, and more rigorous clinical trials are needed before drawing firm conclusions.

Clinical Implications

Despite the uncertainties, the authors recommend caution. Physicians prescribing gabapentin for chronic pain may consider routine cognitive assessments for patients on long-term therapy. Patients, meanwhile, should promptly report symptoms such as confusion, memory problems, or slowed thinking.

Gabapentin, like many medications, also carries other potential risks, including allergic reactions, mood changes, suicidal thoughts, jaundice, and blood in the urine. Patients are strongly advised not to stop the drug abruptly without medical guidance, as this may trigger seizures in those taking it for epilepsy.

Moving Forward

Researchers hope to explore whether gabapentin directly contributes to cognitive decline and, if so, identify the biological mechanisms involved. Until then, doctors and patients alike are urged to remain vigilant about the possible neurological side effects of long-term use.