A large-scale medical records study has revealed concerning associations between gabapentin use and increased risks of dementia and mild cognitive impairment (MCI) in chronic pain patients. The research, published in Regional Anesthesia & Pain Medicine, analyzed data from over 52,000 patients and found that those receiving six or more gabapentin prescriptions for chronic low back pain faced significantly elevated risks of cognitive decline within 10 years.
Study Findings Reveal Dose-Dependent Risk Pattern
The study examined anonymized records from TriNetX, a federated health research network containing electronic health records from 68 healthcare organizations across the United States. Researchers compared 26,414 patients who had been prescribed gabapentin for chronic low back pain between 2004 and 2024 with an equal number of patients who had not received the drug.
Patients who received six or more gabapentin prescriptions demonstrated a 29% increased likelihood of developing dementia and an 85% increased risk of mild cognitive impairment within 10 years of their initial pain diagnosis. The risks escalated with prescription frequency, as those with 12 or more prescriptions showed a 40% increased dementia risk and 65% increased MCI risk compared to patients prescribed gabapentin three to 11 times.
Younger Adults Show Heightened Vulnerability
Perhaps most striking was the finding that risks were more than doubled in patients aged 18-64 years, an age group typically considered too young to develop these conditions. When stratified by age groups, the study revealed no heightened risk among 18-34 year olds, but significant increases emerged in older cohorts.
Among 35-49 year olds prescribed gabapentin, dementia risks more than doubled and MCI risks more than tripled compared to those not prescribed the drug. A similar pattern was observed in the 50-64 age group, indicating particular vulnerability in middle-aged patients.
Clinical Context and Mechanism Concerns
Gabapentin has gained popularity as a chronic pain treatment due to its relatively low addictive potential compared to opioids, offering what researchers describe as "potentially neuroprotective benefits." However, concerns about its side effects have been emerging, including possible associations with neurodegeneration.
The drug works by suppressing communication between nerve cells, which researchers suggest may contribute to cognitive decline. As study lead author Nafis Eghrari, a medical student at Case Western Reserve University in Cleveland, noted, "The findings of this study support the need for close monitoring in adult patients prescribed gabapentin to assess for potential cognitive decline."
Study Limitations and Future Research Directions
The researchers acknowledge several limitations of their observational study design. As a retrospective analysis, they were unable to account for gabapentin dose or length of use, and the observational nature prevents drawing firm conclusions about cause and effect relationships.
"We hope the current study promotes further research to delineate whether gabapentin plays a causal role in the development of dementia and the underlying mechanisms of this relationship," the research team concluded. They emphasized that their findings "provide a foundation to further research whether gabapentin plays a causal role in the development of dementia and cognitive decline."
The study's scope, analyzing real-time data while accounting for demographics, co-existing conditions, and other analgesic drug use, provides a robust foundation for understanding potential cognitive risks associated with gabapentin therapy in chronic pain management.
