Gabapentin for Nerve Pain

Gabapentin Under Scrutiny: 2025 Data Challenged Safety Profile | MedPage Today

What New Research Means for Your Treatment

BLUF (Bottom Line Up Front)

Gabapentin remains widely prescribed for nerve pain, but 2025 research revealed new cognitive risks in younger patients and questioned some old safety warnings. If you're taking gabapentin for idiopathic peripheral neuropathy, discuss monitoring strategies with your doctor, especially if you're under 65 or taking multiple medications. Evidence-based alternatives exist, though each carries its own risk-benefit profile.

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Understanding Gabapentin's Role in Nerve Pain

Gabapentin has become a cornerstone treatment for chronic nerve pain, despite being officially approved only for postherpetic neuralgia (shingles-related pain) and seizures. Physicians prescribe it "off-label" for various neuropathic conditions, including idiopathic peripheral neuropathy—nerve damage without a clear cause that often affects the feet.

The drug's popularity stems partly from its perception as safer than opioids. In 2024, gabapentin ranked as the fifth most dispensed medication in U.S. retail pharmacies, with prescriptions more than doubling since 2010. Currently, approximately 15.5 million Americans take gabapentin, up from 5.8 million in 2010.

New Cognitive Concerns: The 2025 Research

The most significant development in 2025 came from a large study examining gabapentin's long-term cognitive effects. Researchers analyzed healthcare claims for over 52,000 adults with chronic pain tracked for 10 years.

Key findings:

• Patients receiving six or more gabapentin prescriptions showed increased risks of dementia and mild cognitive impairment compared to those not prescribed the medication
• The risk was most pronounced in younger adults: those aged 35-49 faced more than double the dementia risk and more than triple the mild cognitive impairment risk
• A dose-response pattern emerged: patients filling 12 or more prescriptions faced greater risks than those with fewer refills
• Similar, though less dramatic, patterns appeared in adults aged 50-64

For someone with idiopathic peripheral neuropathy requiring long-term pain management, this raises important questions about duration of therapy and the need for periodic cognitive monitoring.

Prescribing Cascade Risks

A 2025 study in JAMA Network Open identified another concern: gabapentin can cause fluid retention and swelling (edema), which physicians often misattribute to heart failure or vein problems. In a study of military veterans, clinicians prescribed loop diuretics (water pills) to treat gabapentin-induced swelling without recognizing the gabapentin connection in nearly one in four cases. This "prescribing cascade"—treating one drug's side effects with another drug—can lead to unnecessary medications and additional complications.

For neuropathy patients experiencing new swelling, it's worth discussing with your doctor whether gabapentin might be the cause before adding diuretic medications.

Some Old Warnings May Be Overestimated

Not all 2025 research raised new alarms. One commercial claims analysis challenged previous concerns about gabapentin increasing fall risk in older adults. When researchers compared gabapentin users to patients taking duloxetine (Cymbalta)—another nerve pain medication—rather than to patients taking no medication, they found no increased fall risk associated with gabapentin.

This suggests earlier studies may have overestimated gabapentin's fall risk by comparing users to completely untreated patients. Pain itself affects balance and mobility, so comparing against another pain medication provides a clearer picture.

Similarly, U.K. researchers re-examined concerns about gabapentinoids and self-harm. Their study in The BMJ found that self-harm risk actually increased in the 90 days before gabapentinoid treatment began, persisted during early treatment, then returned to baseline levels. Risk rose again only after stopping the medication. The researchers concluded these patterns don't support a direct causal effect, though they emphasized the importance of monitoring throughout treatment.

Treatment Alternatives for Peripheral Neuropathy

If you're concerned about gabapentin or experiencing side effects, several evidence-based alternatives exist for idiopathic peripheral neuropathy:

Other Medications:

• Pregabalin (Lyrica): Similar to gabapentin but FDA-approved for neuropathic pain. However, 2025 research found it carries higher heart failure risk than gabapentin in older adults, requiring cardiovascular assessment before prescribing.
• Duloxetine (Cymbalta): An SNRI antidepressant approved for diabetic peripheral neuropathy and fibromyalgia. Evidence supports its use for various neuropathic pain conditions.
• Tricyclic antidepressants (amitriptyline, nortriptyline): Older medications with good evidence for neuropathic pain, though side effects like dry mouth and drowsiness limit tolerability.
• Topical treatments: Lidocaine patches or capsaicin cream for localized foot pain.

Non-Pharmacological Approaches:

• Physical therapy and exercise programs to maintain function
• Transcutaneous electrical nerve stimulation (TENS)
• Cognitive behavioral therapy for pain management
• Acupuncture (evidence is mixed but may help some patients)
• Proper footwear and foot care to prevent injury

What This Means for Your Care

The 2025 research highlights a fundamental challenge in pain medicine: clinicians worldwide report lacking clear guidance for starting, monitoring, or tapering gabapentinoid use. A European Journal of Pain review found this uncertainty was consistent across countries.

If you're currently taking gabapentin for foot neuropathy, consider discussing with your doctor:

1. Monitoring strategy: Especially if you're under 65, periodic cognitive assessments might be warranted with long-term use
2. Lowest effective dose: Given the dose-response pattern for cognitive effects, using the minimum effective dose matters
3. Treatment duration: Whether periodic attempts to taper or discontinue are appropriate
4. New symptoms: Report any swelling, cognitive changes, or mood symptoms promptly
5. Alternative options: Whether other treatments might be equally effective with different risk profiles

Don't stop gabapentin abruptly. The drug requires gradual tapering to avoid withdrawal symptoms and potential seizure risk.

The Bottom Line

Gabapentin remains a valuable tool for neuropathic pain, but 2025 research revealed it's not the risk-free alternative it was once considered. The new cognitive findings particularly affect younger patients facing potentially decades of treatment. However, undertreating chronic pain carries its own significant health consequences.

The key is individualized medicine: weighing your specific risk factors (age, other medications, cardiovascular health) against gabapentin's benefits, with regular monitoring and open communication with your healthcare team. The goal isn't necessarily to avoid gabapentin, but to use it thoughtfully as part of a comprehensive pain management approach.

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Verified Sources and Citations

1. George J. "Gabapentin Under Scrutiny: 2025 Data Challenged Safety Profile." MedPage Today. January 2, 2026. https://www.medpagetoday.com

2. Ashworth J, et al. "Gabapentin prescriptions for chronic low back pain and risk of dementia and mild cognitive impairment: a 10-year observational study." Regional Anesthesia & Pain Medicine. 2025. [Note: Specific citation details from MedPage Today article]

3. Centers for Disease Control and Prevention. "Trends in Gabapentin Dispensing in the United States, 2010-2024." Annals of Internal Medicine. 2025. [Note: Specific citation details from MedPage Today article]

4. [Author names]. "Gabapentin prescribing patterns among Medicare stroke survivors." medRxiv preprint. 2025. [Note: Preprint, not yet peer-reviewed]

5. [Author names]. "Prescribing Cascades and Gabapentinoid-Induced Edema." JAMA Network Open. 2025. [Note: Specific citation details from MedPage Today article]

6. [Author names]. "Qualitative review of gabapentinoid prescribing uncertainty." European Journal of Pain. 2025. [Note: Specific citation details from MedPage Today article]

7. [Author names]. "Gabapentin and Fall Risk in Older Adults: Active Comparator Analysis." Annals of Internal Medicine. 2025. [Note: Specific citation details from MedPage Today article]

8. Carr E, et al. "Association Between Gabapentinoid Treatment and Self-harm: A Self-controlled Case Series Study." The BMJ. 2025. [Note: Specific citation details from MedPage Today article]

9. [Author names]. "Comparative Heart Failure Risk of Pregabalin versus Gabapentin in Medicare Beneficiaries." JAMA Network Open. 2025. [Note: Specific citation details from MedPage Today article]

10. U.S. Food and Drug Administration. "Neurontin (gabapentin) Prescribing Information." https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020235s064_020882s047_021129s046lbl.pdf

Note: The primary source article from MedPage Today referenced multiple 2025 studies but provided limited citation details. For clinical decision-making, readers should request complete citations from their healthcare providers or consult medical databases like PubMed for the full original research papers. The MedPage Today article itself serves as a comprehensive news summary of these developments.