A widely prescribed pain medication used by millions of Americans for chronic back pain may carry an unexpected concern: a possible link to increased risks of dementia and cognitive decline. A new large-scale study suggests that long-term use of gabapentin, a drug commonly viewed as a safer alternative to opioids, could be associated with significant cognitive effects over time.

Researchers from Case Western Reserve University and several partner institutions examined medical records across 68 health systems in the United States. Their analysis focused on 26,414 adults who were prescribed Gabapentin for chronic low-back pain, comparing them with a similar group of patients experiencing back pain who were not given the medication.

The results were striking. Patients who received six or more prescriptions of gabapentin were 29% more likely to be diagnosed with dementia and 85% more likely to develop mild cognitive impairment within ten years. Mild cognitive impairment, often referred to as MCI, is considered an early stage of cognitive decline that can sometimes progress into dementia.

What surprised researchers even more was who faced the greatest increase in risk.

Higher risks among younger adults
While dementia is typically associated with older populations, the study found that younger adults showed some of the most dramatic increases in risk.

Among people aged 35 to 49, those taking gabapentin had more than double the likelihood of developing dementia compared with similar patients who did not take the drug. Their risk of developing mild cognitive impairment was more than three times higher.

Adults aged 50 to 64 also experienced a noticeable rise in risk, though the increases were slightly lower than those seen in the younger group.

Interestingly, the study did not find a significant increase in risk among adults aged 18 to 34.

The findings were published in Regional Anesthesia & Pain Medicine, where researchers emphasized the need for careful monitoring.

“Our results support the need for close monitoring of adult patients prescribed gabapentin to assess for potential cognitive decline,” the study authors wrote.

A pattern linked to frequency of prescriptions
The research also identified a pattern suggesting that greater exposure to gabapentin may correspond with higher risk.

Patients who received 12 or more prescriptions experienced even stronger associations:

40% higher likelihood of dementia

65% higher likelihood of mild cognitive impairment

These patterns remained even after researchers accounted for factors such as demographics, existing health conditions, and the use of other medications.

Important limitation: association, not proof
Despite the concerning findings, the researchers stressed that the study does not prove gabapentin directly causes dementia.

Because the research was observational, it can only show a statistical association, not a cause-and-effect relationship. The team also noted they were unable to analyze the exact dosage patients took or how long they remained on the medication.

Still, the size of the dataset and the consistency of the results add to growing scientific discussions about the drug’s long-term effects.

Why gabapentin prescriptions have surged
Gabapentin has been widely used since the early 1990s, when it was originally approved to treat epilepsy. Over time, physicians began prescribing it for a range of other conditions, including:

Chronic nerve pain

Post-herpetic neuralgia (pain after shingles)

Restless legs syndrome

Persistent back pain

As concerns about opioid addiction increased, gabapentin gained popularity as a perceived safer alternative for managing chronic pain.

However, the drug is known to produce several side effects. Common ones include dizziness, fatigue, swelling from fluid retention, and dry mouth. Some previous studies have also linked gabapentin to potential breathing complications, particularly when combined with other medications.

What the findings mean for patients
Experts say the study should not cause panic but should encourage awareness and careful discussion between patients and doctors.

For people currently taking gabapentin, specialists recommend:

Regular cognitive monitoring, especially during long-term use

Discussing risks and alternatives with healthcare providers

Avoiding unnecessary prolonged treatment when possible

Gabapentin remains an important medication for many patients and is still considered safer than several other pain management options. However, the study highlights the importance of understanding potential long-term risks.

As the researchers concluded, the evidence suggests an association between gabapentin prescriptions and cognitive decline within a decade. Given how widely the medication is used across the United States, the findings offer an important reminder: even commonly prescribed treatments deserve ongoing scrutiny and informed decision-making.