Risk of dementia following gabapentin prescription in chronic low back pain patients

Gabapentin is widely used to treat chronic pain, but its association with cognitive decline and dementia remains unclear. This study examined whether gabapentin prescription is associated with dementia in adults with chronic low back pain. We conducted a retrospective cohort study using the TriNetX national database of de-identified patient records from 2004 to 2024. Adults diagnosed with chronic low back pain were included; those with prior gabapentin use, dementia, epilepsy, stroke, or cancer were excluded. Propensity score matching controlled for demographics, comorbidities, and pain medications. Patients were stratified by age and gabapentin prescription frequency. Primary outcomes were dementia and mild cognitive impairment. 26,416 adults we analyzed following propensity-score matching. Patients with six or more gabapentin prescriptions had an increased incidence of dementia (RR: 1.29; 95% CI: 1.18-1.40) and mild cognitive impairment (RR: 1.85; 95% CI: 1.63-2.10). When stratified by age, non-elderly adults (18-64) prescribed gabapentin had over twice the risk of dementia (RR: 2.10; 95% CI: 1.75-2.51) and mild cognitive impairment (RR: 2.50; 95% CI: 2.04-3.05) compared to those not prescribed gabapentin. Risk increased further with prescription frequency: patients with 12 or more prescriptions had a higher incidence of dementia (RR: 1.40; 95% CI: 1.25-1.57) and mild cognitive impairment (RR: 1.65; 95% CI: 1.42-1.91) than those prescribed gabapentin 3-11 times. Gabapentin prescription in adults with chronic low back pain is associated with increased risk of dementia and cognitive impairment, particularly in non-elderly adults. Physicians should monitor cognitive outcomes in patients prescribed gabapentin.