Millions of Britons taking gabapentin for chronic pain may face significantly heightened dementia risks, according to groundbreaking research that has prompted urgent calls for medication reviews among middle-aged patients.
A comprehensive study has revealed alarming associations between long-term gabapentin use and cognitive decline and found that patients receiving 12 or more prescriptions faced a 40% increased risk of developing dementia compared to those on lower doses.
The Worrying Numbers Behind the Study
A major observational study, published in Regional Anaesthesia & Pain Medicine, analysed data from 68 US-based healthcare institutions.
It found that individuals prescribed gabapentin six times or more had a 29% higher risk of developing dementia and a staggering 85% increase in mild cognitive impairment (MCI). Critically, those receiving 12 or more prescriptions showed a 40% rise in dementia risk, compared to those on fewer doses.
While the dementia risk findings are based on US data, gabapentin remains widely prescribed across the UK. The NHS Business Services Authority (NHSBSA) figures show millions of gabapentin prescriptions are issued each year. Estimates suggest that hundreds of thousands of Britons may be taking the drug regularly, potentially placing a significant patient group at risk.
Dementia Risk Highest Among Middle‑Aged Patients
The study highlighted that the dementia risk was most pronounced in middle-aged patients. Adults aged 35–49 saw more than double the risk of developing dementia compared to non-users, while those aged 50–64 experienced a similarly elevated risk, particularly with prolonged gabapentin use. This age-specific vulnerability may relate to the interaction between medication effects and the early stages of neurodegeneration, which often begin subtly during midlife.
Among younger users aged 18–34, no significant increase in dementia risk was observed, suggesting that the neurological impact of gabapentin may be less pronounced or take longer to manifest in this group. Experts speculate that more prolonged cumulative exposure, combined with age-related changes in brain plasticity, could explain the higher risks seen in middle-aged and older adults.
UK Context: Usage and Precautions
Gabapentin has become a go-to treatment for neuropathic pain and sciatica in the National Health Service (NHS), often prescribed when first-line painkillers provide insufficient relief. Though effective, the drug is not without side effects, and this new evidence suggests a need for heightened caution, especially for patients receiving long-term prescriptions.
Healthcare providers are advised to monitor cognition over time and consider alternative pain management strategies, including physiotherapy, nerve blocks, or conservative analgesics, particularly for middle-aged patients on prolonged courses.
Observational Study Limits: Cause or Correlation?
The research is observational and cannot definitively establish causation. The authors did not have access to details on dosages, duration, or other lifestyle risk factors, such as alcohol use or obesity. This introduces the possibility of confounding variables or reverse causation, where underlying cognitive decline may lead to gabapentin prescriptions rather than vice versa.
Nevertheless, the strong dose–response trend—greater dementia risk with more prescriptions—lends weight to the association.
How Gabapentin Compares to Other Painkillers
In contrast, studies of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin have sometimes hinted at a protective effect when used long-term. For example:
- A Dutch cohort study involving 11,745 older adults found that long-term NSAID use (over 24 months) was associated with a 12% reduced risk of developing dementia, regardless of the total cumulative dose.
- Meta-analyses suggest that extended NSAID exposure may reduce Alzheimer's risk, albeit with significant caveats around gastrointestinal and cardiovascular side effects.
The differing risk profiles underscore the importance of drug-specific assessment rather than generalising across painkillers.
What Patients Should Do Next
Medical professionals stress that people should not cease prescribed gabapentin without guidance. Instead:
- Speak to your GP if you've been on gabapentin for six months or more.
- Ask about cognitive screening or regular check-ins.
- Explore non-drug pain-management options, such as physiotherapy or mindfulness.
- Be aware of other risk factors for dementia, especially chronic inflammation or untreated pain conditions.
With millions of gabapentin prescriptions issued annually across the UK, this study raises pressing questions about the drug's long-term safety, particularly in light of emerging evidence linking frequent use to increased dementia risk. Clinicians and patients alike are now being urged to weigh cognitive health considerations when managing chronic pain.
The findings demand careful balance between effective pain management and potential long-term cognitive consequences, highlighting the need for individualised treatment approaches and regular medication reviews.
