Gabapentin Use Linked to Dementia and Cognitive Impairment Risk among low backache patients: BMJ

A new study published in the journal of Regional Anesthesia and Pain Medicine showed that adults with gabapentin-treated persistent low back pain had a much higher chance of dementia and moderate cognitive impairment (MCI).

One of the leading causes of disability globally is chronic low back pain (CLBP), which is frequently treated with pharmaceutical therapies when conservative methods are ineffective. The effectiveness of gabapentin, an anticonvulsant with analgesic qualities, in treating neuropathic pain disorders has led to its widespread usage. Concerns about its neurocognitive safety profile, especially in older persons, are growing, nevertheless.

Important concerns regarding gabapentin's long-term safety in patients with CLBP are raised by recent research that points to a possible link between its usage and dementia or cognitive deterioration. Given the substantial overlap between the populations at risk for dementia and chronic pain, it is imperative to comprehend this link. Therefore, this study investigated the potential link between dementia and gabapentin prescriptions in persons with persistent low back pain.

Using the TriNetX national database of de-identified medical records from 2004 to 2024, this research carried out a retrospective cohort analysis. Adults having a history of persistent low back pain were included; those with dementia, epilepsy, stroke, cancer, or previous gabapentin usage were not. Propensity score matching adjusted for comorbidities, painkillers, and demographics. Age and the frequency of gabapentin prescriptions were used to stratify the patients. Dementia and moderate cognitive impairment were the main results.

This research examined 26,416 people after propensity-score matching. The patients with 6 or more gabapentin prescriptions showed a higher risk of dementia (RR: 1.29; 95% CI: 1.18–1.40) and moderate cognitive impairment (RR: 1.85; 95% CI: 1.63–2.10).

When categorized by age, gabapentin-prescription non-elderly people (18–64) were more than twice as likely to experience mild cognitive impairment (RR: 2.50; 95% CI: 2.04–3.05) and dementia (RR: 2.10; 95% CI: 1.75–2.51) as those who were not administered gabapentin.

When compared to individuals who received gabapentin 3–11 times, those who received 12 or more prescriptions had a greater incidence of dementia (RR: 1.40; 95% CI: 1.25–1.57) and moderate cognitive impairment (RR: 1.65; 95% CI: 1.42–1.91).

Overall, adults with persistent low back pain who are prescribed gabapentin are more likely to develop dementia and cognitive impairment, especially if they are not old. These problems were more common in patients with 12 or more medicines than in those with 3 to 11 prescriptions. When prescribing gabapentin to patients, doctors should keep an eye on their cognitive progress.

Reference:

Eghrari, N. B., Yazji, I. H., Yavari, B., Van Acker, G. M., & Kim, C. H. (2025). Risk of dementia following gabapentin prescription in chronic low back pain patients. Regional Anesthesia and Pain Medicine, rapm-2025-106577. https://doi.org/10.1136/rapm-2025-106577