According to a large-scale analysis of medical records spanning twenty years, adults have a significantly higher risk of chronic low back pain, especially for disorders under the age of 65.
A study of more than 26,000 patients found that young people taking gabapentin had more than twice the risk of dementia compared to young people who had not prescribed widely used painkillers.
Gabapentin approved epilepsy in 1993, but increasingly prescribed labels for chronic pain, which has become a popular alternative to opioids due to its perceived safety. However, this study suggests that the cognitive effect of the drug may have been underestimated, especially for patients who have received multiple prescriptions over time.
Age-dependent vulnerability
The team analyzed records from 68 health care organizations in the United States, focusing on adults diagnosed with chronic low back pain between 2004 and 2014. After careful matching of patients with similar demographics and health conditions, the researchers tracked cognitive results for a decade.
The results show that the age-related differences in dementia risk are compelling. The risk of prescription gabapentin in non-adult adults (18-64 years old) was significantly higher than that in those who did not take the drug. Among middle-aged patients (35-49), gabapentin users were 244% more likely to develop dementia and 350% more risk of mild cognitive impairment.
Even for patients aged 50-64, the risk increased significantly, with a 228% increase in dementia rate and a 222% increase in mild cognitive impairment. Surprisingly, there is no significant difference in the youngest group (18-34), indicating that vulnerability appears in middle age.
Prescription frequency is important
The study found a study on the dose-response relationship: Patients who received 12 or more prescribed Gabapentin were at a higher risk of dementia than those who were prescribed 3-11 times. This pattern crosses age group, suggesting that cumulative exposure amplifies cognitive danger.
Key findings on prescription frequency include:
- Six or more prescriptions: 29% higher risk of dementia and 85% higher risk of mild cognitive impairment
- Twelve or more prescriptions: The risk of dementia is 40% higher and the risk of mild cognitive impairment is 65% higher
- Dosage Response Mode: Risk of gradual increase in prescription frequency
- Continuous effects: Risks in all age groups except 18-34
The biological mechanism under investigation
Gabapentin works by combining with voltage-gated calcium channels in the brain to reduce the release of excitatory neurotransmitters. Although this mechanism can relieve pain, researchers theorized it may also disrupt normal brain function in ways that promote cognitive decline.
The drug affects calcium channel function through specific protein subunits, which may affect microglia activation and astrocyte dysfunction – a center of dementia development. Some studies have shown that gabapentin reduces neurogenesis and synaptic plasticity in memory-related brain regions, although the exact mechanisms linking acute drug effects to long-term cognitive changes are unclear.
Chronic gabapentin exposure may also alter the levels of gamma-aminobutyric acid (GABA), a crucial neurotransmitter used in brain function. However, the researchers stressed that the relationship between these biochemical changes and therapeutic efficacy and cognitive risk needs further study.
Clinical significance
These findings reached a critical period when healthcare providers increasingly rely on gabapentin as an opioid alternative to chronic pain management. The drug’s reputation for safety and low abuse potential makes it attractive for long-term use, but this study shows that cognitive monitoring may be essential.
The authors of the study highlighted that their work demonstrated associations, not causality. However, consistent patterns across age groups and prescription frequency support require enhanced cognitive monitoring in patients with gabapentin, especially those receiving multiple prescriptions.
For patients currently taking Gabapentin, these findings do not necessarily require immediate drug changes, but emphasize the importance of discussing cognitive risks with healthcare providers. This study highlights the need for careful risk analysis when prescribing chronic pain with gabapentin, especially among young people who may face potential exposure for decades.
Future research may focus on establishing causal relationships and identifying the patient population most susceptible to gabapentin cognitive effects, which may lead to more personalized pain management strategies.
Related
If our report has been informed or inspired, please consider donating. No matter how big or small, every contribution allows us to continue to provide accurate, engaging and trustworthy scientific and medical news. Independent news takes time, energy and resources – your support ensures that we can continue to reveal the stories that matter most to you.
Join us to make knowledge accessible and impactful. Thank you for standing with us!
