Share on PinterestTaking gabapentin for lower back pain is linked to higher dementia risk, a recent study warns. Image credit: Maryanne Gobble/Getty Images.
- Gabapentin is a medication that, in the United States, is approved to treat seizures and shingles-related neuralgia. It is also used off-label to treat other health issues, including low back pain.
- Past studies have also found that using gabapentin may increase a person’s risk of developing cognitive impairment and dementia.
- A new study reports that people who receive six or more prescriptions of gabapentin for lower back pain are at a higher risk of developing dementia and mild cognitive impairment.
- Scientists found these risks were more than doubled in adults between the ages of 35 to 49 years.
Gabapentin is a medication that is approved by the Food and Drug Administration (FDA) for the treatment of some epileptic seizures, moderate-to-severe restless legs syndrome, and postherpetic neuralgia, which is a nerve pain associated with shingles.
Additionally, gabapentin is sometimes prescribed off-label for anxiety disorders, insomnia, hot flashes, alcohol use disorder, akathisia, diabetic peripheral neuropathy, and lower back pain.
Like all medications, gabapentin has some potential side effects, including dizziness, tiredness, water retention, and dry mouth. Past studies have also found that using gabapentin may cause breathing difficulties, and may increase a person’s risk of developing cognitive impairment and dementia.
Now, a new study published in the journal Regional Anesthesia & Pain Medicine reports that people who receive six or more prescriptions of gabapentin for lower back pain are at a higher risk of developing dementia and mild cognitive impairment (MCI).
Scientists also discovered these risks were more than doubled in adults between the ages of 35 to 49 years.
Gabapentin: How does it affect dementia, MCI risk?
For this study, researchers analyzed data from more than 26,000 adults through the federated health research network TriNetX.
Scientists selected participants who had a diagnosis of chronic pain, chronic pain syndrome, lumbar radiculopathy, and chronic low back pain. They also categorized study participants into different age groups: 18–64, 18–34, 35–49, 50–64, and 65 or older.
Researchers assess 10-year outcomes on study participants to see what percentage developed dementia, generally, or specifically Alzheimer’s disease, vascular dementia, or MCI.
“Currently, there is a discrepancy on whether taking gabapentin increases a patient’s risk for developing dementia,” Nafis B. Eghrari, a 4th-year medical student at Case Western Reserve University School of Medicine in Cleveland, OH, and first author of this study, told Medical News Today.
“Moreover, there lacks a strong understanding of how gabapentin impacts cognitive function and whether it contributes to neurodegenerative processes. Previous studies have shown mixed findings on this topic. Thus, we decided to explore this gap in the field,” explained Eghrari.
6 or more gabapentin prescriptions linked to 85% higher MCI risk
Upon analysis, researchers found that study participants who received six or more gabapentin prescriptions had a 29% higher risk of developing dementia, and an 85% greater chance of being diagnosed with MCI.
“The significance of this finding is an association between gabapentin prescription and dementia on a nationwide level,” Eghrari explained. “Though this does not imply causation, this warrants further investigation on the drug’s long-term effects.”
“In terms of clinical significance, I recommend that physicians prescribing gabapentin for chronic pain perform cognitive exams on a regular basis when seeing patients,” he continued.
“I’d also advise patients who are taking this drug to alert their physician if they notice any cognitive deficits, including confusion, poor memory, or slowed thinking,” said the researcher.
Risks doubled in 35–49-year-olds
Eghrari and his team also discovered that when looking at participants by age groups, the risks for dementia more than doubled and more than tripled for MCI in people who were 35 to 49 years old.
“We were surprised to find this relatively higher risk in the non-elderly population,” Eghrari said.
“These results indicate that gabapentin may have a greater cognitive impact on non-elderly individuals, as elderly individuals are already at risk for neurodegeneration due to their older age. This finding warrants further investigation into the underlying mechanism of how gabapentin may impact cognition.”
– Nafis B. Eghrari
“The key takeaway of this study is that patients prescribed gabapentin for chronic back pain should be closely monitored by their physician for cognitive decline,” he continued. “Moreover, gabapentin should be prescribed with caution due to the associated risk of dementia/cognitive impairment.”
“We hope to carry this research forward and explore whether there is a true causative relationship between gabapentin and cognitive impairment,” Eghrari added. “We also plan to investigate the underlying mechanisms of how the drug may impact cognition.”
What are the drawbacks of large dataset studies?
MNT had the opportunity to speak with Neel Anand, MD, MCh Orth, a board-certified orthopedic spine surgeon and director of the Cedars-Sinai Spine Center in Los Angeles, about this study.
Anand, who was not involved in the research, commented that there are pros and cons to studies with big data sets as there are many variables and it is hard to determine the true causative factor.
Additionally, little or no information was provided on any other illnesses participants may have had or other medications they were taking.
“The best thing I would take from the study is […] [that] there’s not a single drug without a side effect — they all have some issues,” Anand pointed out. “So the answer is, if you’re chronically going to take something, you better watch out — something’s [potentially] going to go wrong somewhere.”
Anand said the best way to prove anything is to take a cohort of study participants who take a specific medication and nothing else, and compare them to another cohort who does not take the medication. And researchers need to ensure that participants take the medication if it is prescribed to them.
He noted that, in some cases, patients do not follow the doctor’s indications regarding prescription medication.
“Sometimes they do more, sometimes they’ll take less,“ Anand said. “The only way to actually study [the real-life effects of long-term drug use] would be to literally take a thousand people and give them gabapentin and nothing else, and a thousand you don’t, and then follow them over 5 years or more,” he suggested.
Still, he admitted that “at least we can be cognizant“ that there may be a heightened risk of dementia with prolonged gabapentin use.
That is “a possibility that [doctors] needs to be aware [of] or at least counsel our patients [on] — that’s fair,” Anand added.
