Gabapentin, a widely prescribed medication for nerve pain, seizures, and anxiety, has long been considered a safer alternative to opioids. However, recent research has raised concerns about its long-term impact on cognitive health, suggesting a possible link between gabapentin use and increased risk of dementia. 

A 2025 study published in Regional Anaesthesia & Pain Medicine analysed the medical records of 26,416 adults with chronic low back pain and found that those who received six or more gabapentin prescriptions were 29% more likely to develop dementia and 85% more likely to develop mild cognitive impairment (MCI) within ten years. The risk was especially pronounced among adults aged 35 to 49, a demographic not typically considered high-risk for cognitive decline.

The study’s authors suggest gabapentin’s mechanism - dampening excitatory neural activity by binding to calcium channels - may inadvertently interfere with cognitive processes such as memory and attention. While the findings are observational at present, and do not establish causation, they highlight a concerning correlation.

The study has sparked a lively discussion among healthcare professionals. One commenter noted, “We’ve been prescribing gabapentin like candy for years - this should be a wake-up call.” Another added, “It’s time we revaluate the long-term cognitive risks of non-opioid pain management strategies.” Others urged caution, emphasising that chronic pain itself and associated conditions like depression and sleep disorders may also contribute to cognitive decline.

Clinically, the study suggests physicians should monitor cognitive function in patients receiving long-term gabapentin therapy, especially younger adults who may be more susceptible to neurological side effects. Alternatives to gabapentin, such as pregabalin, duloxetine, amitriptyline, and non-pharmacological approaches like physical therapy, may offer safer options for managing chronic pain.

Despite its relatively low addictive potential, gabapentin is not without risks. Patients have reported symptoms such as brain fog, memory lapses, and slowed information processing, which can interfere with daily functioning. These cognitive side effects, though often subtle, may accumulate over time and impact quality of life.

Ultimately, while gabapentin remains a valuable tool in pain management, its long-term safety profile and impact on cognitive functioning deserves closer scrutiny. As one professional aptly summarised, “Pain management shouldn’t come at the cost of cognitive health. We owe it to our patients to dig deeper.”

The emerging data on gabapentin’s cognitive risks adds a new layer of complexity for insurers navigating both chronic pain claims and those arising following brain injury. The link between gabapentin and dementia underscores the importance of thoroughly reviewing a claimant’s medical history and list of medications when considering causation and exploring whether there could be other, non-organic, causes for cognitive decline.