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Gabapentin is an anticonvulsant medication that is FDA approved for the treatment of seizure disorders and postherpetic neuralgia—a chronic, often debilitating, nerve pain syndrome often linked to shingles. It is classified as an anticonvulsant and a GABA analogue, meaning it mimics the neurotransmitter gamma-aminobutyric acid (GABA), which normally reduces nerve excitability. An extended-release version (gabapentin enacarbil) is approved for restless legs syndrome.
Gabapentin works by calming overactive nerve activity in the brain and nervous system, primarily through interactions with calcium channels. However, it is also frequently prescribed off label for a variety of chronic pain conditions and generally viewed as a safer alternative to opioids. As a result, over the last 15 years, prescriptions for gabapentin have increased dramatically. This coincides with burgeoning awareness of and concern about the opioid epidemic that began around this time, and subsequent to the significant relaxing of opioid prescribing standards to include chronic pain conditions.
A September 2025 report by CDC researchers in Annals of Internal Medicine documented gabapentin’s rapid rise in the U.S. Prescriptions for gabapentin per 1,000 people more than doubled from 2010 to 2024, while the number of Americans taking this medication nearly tripled—from 5.8 million to 15.5 million. In 2024 gabapentin was the fifth most dispensed drug in U.S. retail pharmacies.[1]
More Prescriptions = Greater Risk
But perhaps the most concerning recent finding about gabapentin came from a 2025 study that linked gabapentin prescriptions for chronic low back pain with increased risks for cognitive impairment and dementia, especially in younger people. Among more than 52,000 adults tracked over the course of 10 years through U.S. healthcare claims records, chronic pain patients with six or more gabapentin prescriptions had a higher incidence of mild cognitive impairment and dementia compared with those who were not prescribed gabapentin. The research, published in Regional Anesthesia & Pain Medicine, found that dementia risk was more than double, while mild cognitive impairment risk was more than triple, among those ages 35 to 49. Results among those ages 50 to 64 years were similar.[2]
This research was based on a retrospective cohort study of more than 26,000 adults diagnosed with chronic low back pain using the TriNetX national database of de-identified patient records from 2004 to 2024. Importantly, those with prior gabapentin use, dementia, epilepsy, stroke, or cancer were excluded. Risks for both cognitive impairment and dementia increased further with prescription frequency: Patients with 12 or more prescriptions had a higher incidence of both conditions than those prescribed gabapentin 3-11 times.
Adding fuel to this unease, a recent analysis in JAMA Network Open questioned whether prescribing cascades—a pattern in which the adverse effects of one medication are treated with another—were tied to gabapentinoid-induced edema. A study of medical records of gabapentin-treated military veterans showed that clinicians almost never explicitly considered gabapentinoid effects when treating edema with diuretics, commonly attributing fluid build-up to congestive heart failure or venous stasis. Nearly one in four patients had potential harms from such a resulting prescribing cascade.[3]
Moreover, global research mirrors U.S. concerns. A 2025 review of qualitative studies in the European Journal of Pain indicated that uncertainty was a recurring theme, with clinicians worldwide saying there was lack of guidance for starting, monitoring, or tapering gabapentinoid use.[4]
Gabapentin and Self-Harm
Long-standing fears about gabapentin and self-harm also were re-examined in a U.K. self-controlled case series published in the BMJ in April 2025. It found that self-harm risk rose in the 90 days before gabapentin treatment, persisted during the early treatment period before dropping to a reference level, and rose again within 14 days after treatment stopped. While the findings didn’t support a direct effect of gabapentin related to self-harm, it demonstrates the importance of careful patient monitoring of self-harm throughout the process of treatment with gabapentin.[5]
Full disclosure: I began my personal recovery journey after being on prescription opioids for eight years for my own chronic pain in late 2006. Subsequently, I took gabapentin for approximately two years. I chose to discontinue it after being unable to identify any notable beneficial effects and in consultation with my prescribing physician.
Chronic Pain Essential Reads
The common side effects of gabapentin include drowsiness, dizziness, blurry or double vision, and difficulty with coordination and concentration. Chronic pain frequently causes tremendous and wearying distress for those afflicted with it. However, it’s essential for medical professionals to ensure (to the maximum extent possible) that the treatment doesn’t create more problems than it ameliorates.
Copyright 2026 Dan Mager, LCSW
