Nerve Pain Drug Gabapentin Linked to Increased Dementia Risk

Gabapentin is one of the most commonly prescribed drugs for nerve-related pain. From diabetic neuropathy to chronic low back pain, it’s widely used by primary care doctors and pain specialists alike. Many see it as a safer alternative to opioids. It doesn’t carry the same risks of respiratory depression or addiction. But that doesn’t mean it’s without danger, as our Austin manual physical therapist can explain.

What Is Gabapentin and How Does It Work?

Gabapentin is not a traditional pain reliever. It was originally developed as an anti-seizure medication. It works by inhibiting voltage-gated calcium channels in the nervous system, which reduces the release of excitatory neurotransmitters. This has a calming effect on overactive nerve pathways.

While this can help reduce pain from nerve irritation, it may also dampen normal brain function. That’s where the potential risk lies: slowing down the brain’s signal processing may contribute to cognitive side effects over time.

Why Gabapentin Is Prescribed and What It’s Used For

Gabapentin was originally developed as an anti-epileptic drug, but over time, doctors began prescribing it for a wide range of nerve-related issues. Today, it is most commonly used to manage neuropathic pain, a type of pain that occurs when nerves are damaged or overly sensitive.

Common uses include:

Peripheral neuropathy – Often seen in diabetes, causing numbness, tingling, or burning in the hands and feet. This is one of the most common issues we treat here at Move Empower Concierge Physical Therapy.
Postherpetic neuralgia – Nerve pain that lingers after a shingles outbreak.
Sciatica and lumbar radiculopathy – Shooting pain from the lower back into the leg due to nerve compression or irritation.
Fibromyalgia – A chronic pain condition involving widespread sensitivity and fatigue.
Seizure disorders – Although less common now, gabapentin is still used for some types of seizures.
Hot flashes and anxiety (off-label) – Some providers prescribe it for non-pain conditions, though it’s not FDA-approved for those uses.

A new study raises serious concerns about gabapentin’s long-term effects on the brain. Researchers have found that people who take gabapentin frequently may be at higher risk for developing dementia or other forms of cognitive decline. These findings suggest a need to reconsider the role of gabapentin in long-term pain care and highlight the value of non-drug approaches like physical therapy.

What the Data Shows

A large observational study published in Regional Anesthesia & Pain Medicine (BMJ Group) looked at patients with chronic low back pain who were prescribed gabapentin. The findings were alarming:

29% higher risk of dementia in patients who received six or more prescriptions of gabapentin
85% higher risk of mild cognitive impairment (MCI) in the same group
For those aged 35 to 49, dementia risk more than doubled, and MCI risk more than tripled
Risks were dose-dependent and the more prescriptions a patient received, the higher the risk

Importantly, these findings were based on electronic health records, making them one of the largest analyses of gabapentin’s long-term cognitive effects to date. While observational, the study adjusted for multiple confounding variables like age, sex, and comorbidities.

Side Effects That Raise Red Flags

Even before this new study, patients and providers had noticed cognitive effects from gabapentin. Common side effects include:

Brain fog – Feeling mentally sluggish, difficulty concentrating, or feeling “off.”
Memory issues – Trouble recalling names, words, or tasks. Patients often report short-term memory lapses.
Confusion – Disorientation, slower decision-making, or difficulty understanding instructions.
Drowsiness – Daytime fatigue, trouble staying alert, or needing more naps than usual.
Dizziness and poor coordination – Feeling off balance or clumsy, especially in older adults.
Mood changes – Some users experience increased depression, irritability, or anxiety.
Speech difficulties – Slurred speech or trouble finding words have been reported.
Visual changes – Blurred vision or double vision may occur in some individuals.
Dependence – While not traditionally addictive, gabapentin can lead to physical dependence, especially when taken for months or years.

These side effects often go underreported, especially in older adults, where memory loss may be attributed to aging. It is easy to say you forgot something simply because you are getting older. But with new research connecting frequent gabapentin use to long-term cognitive decline, these symptoms take on new urgency. If you’re experiencing these side effects, it’s important to document them and discuss alternatives with your healthcare provider. Even if you are not taking this specific drug, these kinds of symptoms are important to keep track of and address immediately. Start writing down the dates that this occurs and what exactly happens, then reach out to your doctor.

Understanding the Brain-Pain-Cognition Triangle

Chronic pain itself is already linked to cognitive decline. Long-term pain disrupts sleep, increases stress, and changes brain structure. Regions in the brain like the hippocampus (involved in memory) and the prefrontal cortex (involved in decision-making) may shrink or become less active in people with untreated chronic pain.

Now add gabapentin to the mix which is another factor that slows brain activity, and you have a perfect storm for memory loss, mental fog, and eventually, dementia.

This is especially concerning for patients who are relatively young (30s to 50s) and plan to take gabapentin for years. The brain’s plasticity which is the ability to grow and change may be reduced by long-term drug exposure.

How Physical Therapy Offers a Safer, Smarter Option

Physical therapy doesn’t work like a pill. It doesn’t mask pain. It helps you treat it at the source. PT supports nerve health, movement function, and brain activity in ways that can actually reverse the processes that worsen chronic pain.

Here’s how:

1. Improving Nerve Mobility and Health

Many cases of neuropathy or nerve pain are related to poor nerve glide, compression, or irritation. Physical therapists assess how nerves move, and use techniques like:

Nerve gliding (neurodynamic mobilization)
Postural correction
Soft tissue release

These help reduce sensitivity at the nerve root and along its path. Again, this is one of the most common issues we deal with when treating neuropathy. Hear from one of our happy customers on this topic:

2. Restoring Movement to Reduce Pain Signals

Pain often arises when the body is out of balance and muscles aren’t supporting joints, or movement patterns are altered by fear or stiffness. PT restores normal movement using:

Strength training
Flexibility exercises
Core stabilization
Gait and posture training

This lowers the overall pain signal to the brain.

3. Educating the Nervous System

Pain neuroscience education (PNE) helps patients understand that not all pain signals mean tissue damage. When people learn how the nervous system can stay in “alert mode” even after healing, they become less fearful and move more. That movement helps rewire the brain toward safety, not threat.

4. Reducing Inflammation and Enhancing Circulation

Exercise has systemic benefits: it improves circulation, reduces inflammation, and boosts neurotransmitters like serotonin and dopamine. These effects support both pain relief and brain health.

5. Supporting Cognitive Health Through Activity

Unlike gabapentin, which may dull the brain, physical activity activates it. PT-led movement improves memory, focus, and neuroplasticity. Aerobic exercise and strength training are proven to support executive function and slow brain aging.

Gabapentin works by calming overactive nerve signals. This can be helpful in short-term situations when nerve pain is severe or disruptive. However, because it alters brain chemistry, long-term use can carry unintended consequences when it comes to thinking, memory, and brain health.

If you’re currently prescribed gabapentin, don’t panic but do ask:

How long should I take this medication?
Are there non-drug ways to manage my nerve pain?
What are the signs of cognitive side effects?
Can I try physical therapy while on this medication?

You can also ask your physical therapist:

Can you check if my nerve pain is related to poor movement or posture?
Can we build a program to reduce my symptoms naturally?

If your physical therapist determines your pain is due to neuropathy, here are some examples of PT-guided interventions to address your pain points:

For cervical or thoracic radiculopathy:

Cervical retraction and nerve sliders
Postural correction for forward head
Upper thoracic mobility exercises

For lumbar radiculopathy/sciatica:

Sciatic nerve glides
Core activation and pelvic alignment training
Hip mobility and gait retraining

For peripheral neuropathy:

Sensory stimulation
Balance training
Foot and ankle strengthening

These are just examples and each program is tailored to the individual. These might sound overwhelming, but our team takes the time to carefully explain what each of these means, how they will affect your body, and a general timeline of how long you will have to do these.

A Smarter Path to Pain Relief

Gabapentin has a place in short-term nerve pain management. But long-term use may come with costs for brain health.

With the right support, many patients can reduce or avoid the need for long-term medications. Physical therapy offers a drug-free, personalized, and evidence-based approach to treating nerve pain at its source.

If you’re concerned about the risks of gabapentin or just want a better plan for managing your nerve pain, talk to your doctor and schedule an evaluation with a physical therapist. It’s never too late to move toward a safer, smarter path to healing. Reach out to us for a FREE discovery session where we determine what is causing your pain and create a custom plan on how to overcome it so you can get back to doing the things you love.