Risk of dementia increased with gabapentin prescription in back pain patients

1. Gabapentin use was associated with a 29% increased risk of dementia and 85% increased risk of mild cognitive impairment (MCI) in chronic low back pain patients.

2. Non-elderly adults (18–64 years) had over twice the risk of dementia and MCI with gabapentin use compared to non-users.

3. The risk of cognitive decline increased with higher frequency of gabapentin prescriptions.

Evidence Rating Level: 2 (Good) 

This large retrospective cohort study investigated the association between gabapentin use and the development of dementia and mild cognitive impairment (MCI) in adults with chronic low back pain. Using deidentified data from the TriNetX national database spanning 2004 to 2024, the authors identified over 1.4 million eligible patients, ultimately including 26,416 gabapentin users and an equal number of matched controls after propensity score matching for demographics, comorbidities, and pain medications. Patients prescribed gabapentin six or more times after diagnosis were found to have significantly higher risks of both dementia (RR 1.29; 95% CI 1.18–1.40) and MCI (RR 1.85; 95% CI 1.63–2.10) within 10 years. The effect was more pronounced in non-elderly adults (18–64 years), with risk ratios exceeding 2.0, particularly in the 35–64 age group. A dose-response relationship was observed: those with 12 or more prescriptions had a higher incidence of both dementia and MCI than those with 3–11 prescriptions. The study concludes that gabapentin use in chronic low back pain is associated with increased risk of neurocognitive decline, and clinicians should be vigilant in monitoring long-term cognitive outcomes, especially in younger patients and those requiring prolonged therapy.

Click to read the study in RAPM

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