A pain medication that millions of Americans rely on for chronic back pain may come with a hidden risk: a significantly higher chance of developing dementia or other cognitive problems, according to a major new study.

Compared 26,000 adults

Researchers from Case Western Reserve University and several partner institutions analyzed medical records from 68 health systems across the U.S., comparing 26,414 adults prescribed gabapentin for persistent low-back pain with a matched group who had similar pain — but didn’t take the drug.

Their finding was sobering: Adults who received six or more gabapentin prescriptions were 29% more likely to be diagnosed with dementia and 85% more likely to develop mild cognitive impairment (MCI) within 10 years.

The risk wasn’t limited to older adults. In fact, it was younger Americans who saw the most dramatic increases.

Younger adults saw shocking risk increases

For people normally considered decades away from dementia:

• Ages 35–49 taking gabapentin had more than double the risk of dementia.
• Their risk of MCI more than tripled.
• Adults 50–64 saw similarly elevated risks.
• Only those 18–34 showed no increased risk.

Researchers published their results in Regional Anesthesia & Pain Medicine and didn’t mince words: “Our results support the need for close monitoring of adult patients prescribed gabapentin to assess for potential cognitive decline.”

More prescriptions = more risk

Like any medication, gabapentin can cause side effects. Some of the more common ones include feeling dizzy, unusually tired, experiencing swelling from fluid retention, and having a dry mouth. Earlier research has also linked gabapentin use to potential breathing problems.

However, the study from Case Western Reserve University found a clear pattern: the more gabapentin someone took, the greater the cognitive risks.

• Those with 12+ prescriptions were 40% more likely to develop dementia.

• They were 65% more likely to develop MCI.

This held true even after accounting for health conditions, demographics, and other medications.

But does gabapentin cause dementia?

Not necessarily. The researchers were careful to note this was an observational study, meaning it shows a strong association — not proof of direct cause.

They also couldn’t analyze exact dosage or duration.

Still, the dataset was huge, and the findings aligned with other emerging concerns about gabapentin’s side effects.

Why gabapentin use has skyrocketed

Gabapentin has been around since the early ’90s, originally approved to treat epilepsy. Over the years, doctors have increasingly turned to it for chronic pain, nerve pain, post-shingles pain, and restless legs syndrome because it’s seen as a safer alternative to opioids.

It’s often prescribed long-term for back pain, even though researchers note that many patients receiving it may also struggle with mobility — another known dementia risk factor.

But in this study, gabapentin users were matched with similarly limited patients who didn’t take the drug, suggesting mobility alone doesn’t explain the cognitive decline.

What this means for patients

The takeaway isn’t to panic, but to be informed.

If you or a loved one is taking gabapentin for back pain, experts say the study reinforces the importance of:

• Regular cognitive check-ins
• Talking with your doctor about risks and alternatives
• Avoiding unnecessary long-term use when possible

Gabapentin is still considered safer than many pain medications, but awareness matters.

As the researchers conclude, “Our findings indicate an association between gabapentin prescription and dementia or cognitive impairment within 10 years.”

Given the drug’s widespread use, that’s a message worth paying attention to.