Tuesday, January 20, 2026

Puppy Linux on your mini PC.

 

Puppy Linux Software Overview

Puppy Linux is designed as a lightweight, fast system that includes essential software out-of-the-box while making it easy to add more applications as needed.

Built-in Software (Typical Puppy Distribution)

Desktop Environment

  • JWM (Joe's Window Manager) or OpenBox: Ultra-lightweight window managers
  • ROX-Filer: Fast, icon-based file manager with desktop icon support
  • Multiple desktop backgrounds and theming options

Internet & Communication

  • Default web browser: Usually a lightweight browser
    • Pale Moon (Firefox-based, lighter)
    • Chromium or Iron (in some versions)
    • Newer Puppies may include Firefox ESR
  • Email client: Claws Mail or Sylpheed (lightweight, feature-rich)
  • Chat: Pidgin or similar multi-protocol messenger
  • FTP client: gFTP
  • RSS reader: Built into some browsers or standalone
  • Network tools: Extensive network configuration utilities

Office & Productivity

  • Text editor: Geany (programmer's editor with syntax highlighting)
  • Simple text editor: Leafpad or similar
  • PDF viewer: ePDFView or similar lightweight reader
  • Spreadsheet: Gnumeric (lightweight alternative to Excel)
  • Word processor: AbiWord (lightweight, can handle .doc/.docx)
  • Calculator: Basic calculator application
  • Note-taking: Various simple note apps

Graphics & Imaging

  • Image viewer: Viewnior or GPicView (fast image browser)
  • Screenshot tool: mtPaint or built-in screenshot utility
  • Basic image editor: mtPaint (surprisingly capable for basic editing)
  • Scanner support: XSane (if you have a scanner)
  • PDF creator: Supports creating PDFs from various applications

Multimedia

  • Audio player: Deadbeef, XMMS, or similar lightweight player
  • Video player: Usually MPV or MPlayer (plays most formats)
  • CD/DVD burning: Pburn (Puppy's custom burning application)
  • Audio recording: Audacity (in some versions) or simpler recorders
  • Volume control: RetroVolume or similar mixer

System Utilities

  • Package manager: Puppy Package Manager (PPM) - install/remove software
  • System information: Hardware detection and reporting tools
  • Disk utilities: GParted (partition editor), disk usage analyzers
  • Archive manager: File compression/decompression (tar, zip, rar, 7z, etc.)
  • Process monitor: System monitor showing CPU, RAM, processes
  • Backup tools: Built-in backup utilities for save files
  • Firewall: Basic firewall configuration tool
  • Printer setup: CUPS configuration utilities

Programming & Development

  • Geany: Full-featured programmer's text editor
  • Terminal: Multiple terminal emulators (urxvt, xterm)
  • Scripting: Bash shell scripting environment
  • Basic compilers: Some versions include gcc, Python

Accessibility

  • Screen magnifier: Available in accessibility tools
  • On-screen keyboard: For touchscreen or accessibility needs

Available Software Additions

Puppy Linux has access to thousands of additional applications through multiple sources:

Installation Methods

1. Puppy Package Manager (PPM)

The primary software installation tool with access to:

  • Official Puppy repositories: Puppy-specific packages
  • Ubuntu repositories (FossaPup): Thousands of Ubuntu packages
  • Debian repositories (BookwormPup): Massive Debian software collection
  • Slackware packages (Slacko Puppy): Classic Slackware software
  • Pet packages: Puppy-specific format (.pet files)

2. SFS (SquashFS) Files

Compressed file systems that load into RAM:

  • Large applications packaged as single files
  • Language packs and localization
  • Development environments
  • Load/unload without installation
  • Available from Puppy forums and repositories

3. AppImages

Portable applications that run without installation:

  • Download and run immediately
  • No system modification needed
  • Growing library of modern applications

4. Flatpak (newer Puppies)

  • Access to Flathub repository
  • Thousands of modern applications
  • Sandboxed for security

Popular Software Additions

Office & Productivity

  • LibreOffice: Full office suite (word, spreadsheet, presentations)
  • FreeOffice: Alternative lightweight office suite
  • PDFtk: Advanced PDF manipulation
  • Scribus: Desktop publishing
  • GnuCash: Accounting software
  • Project management: Planner, ProjectLibre

Graphics & Design

  • GIMP: Full-featured image editor (Photoshop alternative)
  • Inkscape: Vector graphics editor (Illustrator alternative)
  • Blender: 3D modeling and animation
  • Krita: Digital painting
  • darktable: Photo workflow and RAW processing
  • Shotwell: Photo organizer
  • MyPaint: Simple painting application

Multimedia

  • VLC: Powerful media player (all formats)
  • Audacity: Professional audio editing
  • Kdenlive: Video editing
  • OpenShot: Simpler video editor
  • HandBrake: Video transcoding
  • Spotify: Music streaming (via Flatpak)
  • OBS Studio: Screen recording and streaming

Internet & Communication

  • Google Chrome: Full-featured browser
  • Thunderbird: Full-featured email client
  • Skype: Video calling (via Flatpak or web)
  • Telegram: Messaging
  • Discord: Gaming/community chat
  • FileZilla: Advanced FTP client
  • Transmission: BitTorrent client
  • qBittorrent: Alternative torrent client

Development & Programming

  • VSCode/VSCodium: Modern code editor
  • Eclipse: Java IDE
  • Python (full installation with pip)
  • Node.js: JavaScript runtime
  • Git: Version control
  • Docker: Containerization (on capable systems)
  • Vim/Emacs: Advanced text editors
  • Lazarus: Pascal/Delphi IDE

Games

  • Steam: Gaming platform (possible via Flatpak)
  • 0 A.D.: Historical RTS game
  • SuperTuxKart: Racing game
  • Battle for Wesnoth: Turn-based strategy
  • Frozen Bubble: Puzzle game
  • PySolFC: Solitaire collection
  • DOSBox: DOS emulator for classic games
  • Wine: Run some Windows games/apps

Science & Education

  • Stellarium: Planetarium software
  • Celestia: Space simulation
  • GeoGebra: Mathematics software
  • Scilab: Mathematical computation (MATLAB alternative)
  • Octave: Numerical computation
  • R: Statistical computing
  • Maxima: Computer algebra system

System & Utilities

  • Timeshift: System backup and restore
  • Bleachbit: System cleaning
  • KeePassXC: Password manager
  • Syncthing: File synchronization
  • rsync: Advanced file copying
  • Rclone: Cloud storage sync
  • htop: Advanced process monitor
  • GSmartControl: Hard drive monitoring

File Management

  • Midnight Commander: Text-based file manager
  • Double Commander: Dual-pane file manager
  • Thunar: Alternative graphical file manager
  • FreeFileSync: File synchronization
  • Unison: Bidirectional file sync

Special Puppy Linux Features

SFS Loading System

Unique to Puppy - load entire applications on-demand:

  • LibreOffice SFS: Load complete office suite when needed
  • Development SFS: Programming tools as one package
  • Language packs: Additional language support
  • Codec packs: Multimedia codecs
  • Load multiple SFS files simultaneously
  • Unload when not needed to save RAM

devx SFS

Development environment in one SFS file:

  • Complete compilation tools (gcc, make, headers)
  • Development libraries
  • Essential for compiling software from source
  • Load only when developing

Pet Package System

Puppy-specific packages with features:

  • Dependency resolution
  • Pre-configured for Puppy
  • Optimized size
  • Available from Puppy forums

Finding and Installing Software

Where to get software:

  1. Puppy Package Manager (built-in)

    • Menu → Setup → Puppy Package Manager
    • Browse by category
    • Search by name
    • Automatic dependency handling
  2. Puppy Linux Forums

  3. Ibiblio Repository

  4. Flathub (if Flatpak enabled)

  5. AppImageHub

Installation Tips

For small applications:

  • Use Puppy Package Manager (easiest)
  • Install directly from repositories

For large applications (100MB+):

  • Consider SFS files (load on demand)
  • Saves disk space
  • Can unload when not needed

For newer applications:

  • Try Flatpak or AppImage versions
  • Often more current than repository packages

For Windows software:

  • Wine may work for some applications
  • PlayOnLinux simplifies Wine usage
  • Not all Windows apps will work

RAM Considerations

Since Puppy runs in RAM:

  • Your 8GB is plenty for typical use
  • Large applications (GIMP, LibreOffice) will use RAM
  • SFS files load into RAM when active
  • Monitor RAM usage if loading multiple large SFS files
  • Can use swap space if needed

The beauty of Puppy is you can start minimal and add exactly what you need, keeping the system fast and efficient!

How to Install 

The Intel Celeron J4125 is a relatively modern processor (2019, Gemini Lake), so you'll want a current Puppy Linux version that can take advantage of it.

Recommended Puppy Linux Version

For your J4125 system, I recommend FossaPup64 9.5 or BookwormPup64 10.0.x (the latest). Both are 64-bit versions that will work well with your hardware:

  • FossaPup64 9.5: Based on Ubuntu 20.04, very stable
  • BookwormPup64 10.0.x: Based on Debian 12, more recent software

What You'll Need

  1. Your large USB drive (8GB minimum, though Puppy only needs ~400MB)
  2. A working computer to prepare the USB
  3. Rufus (for Windows) or Etcher (for Windows/Mac/Linux) to create the bootable USB

Step-by-Step Instructions

Phase 1: Download Puppy Linux

  1. On your current working computer, visit the official Puppy Linux download site:

  2. Download your chosen version:

    • For FossaPup64: Look for fossapup64-9.5.iso (~400MB)
    • For BookwormPup64: Look for bookworm64-10.0.x.iso (~500MB)

Phase 2: Create Bootable USB Drive

Using Rufus (Windows):

  1. Download Rufus from https://rufus.ie/
  2. Insert your USB drive
  3. Launch Rufus
  4. Configure settings:
    • Device: Select your USB drive
    • Boot selection: Click SELECT and choose your downloaded Puppy .iso file
    • Partition scheme: GPT (for UEFI) or MBR (for older BIOS) - GPT is safer for modern systems
    • Target system: UEFI (or BIOS/UEFI if unsure)
    • File system: FAT32
    • Leave other settings as default
  5. Click START
  6. If prompted about ISOHybrid or DD mode, select ISO mode (recommended)
  7. Wait for completion (2-5 minutes)

Using Etcher (Any OS):

  1. Download Etcher from https://etcher.balena.io/
  2. Launch Etcher
  3. Click "Flash from file" and select your Puppy .iso
  4. Click "Select target" and choose your USB drive
  5. Click "Flash!"

Phase 3: Prepare Your Mini PC

  1. Back up any data from the mini PC if needed

  2. Insert the USB drive into the mini PC

  3. Access BIOS/UEFI settings:

    • Power on the mini PC
    • Immediately press the BIOS key repeatedly (usually F2, F12, DEL, or ESC)
    • Common keys for mini PCs: F2, F7, F10, F12, DEL
  4. Configure boot settings:

    • Find the "Boot" or "Boot Order" menu
    • Set USB drive as first boot priority
    • If available, disable Secure Boot (in Security settings)
    • Save and Exit (usually F10)

Phase 4: First Boot and Installation

  1. Boot from USB:

    • The mini PC should boot to Puppy Linux menu
    • Select the first option (usually "puppy" or default boot)
    • Wait 30-60 seconds for Puppy to load into RAM
  2. Initial Setup Wizard:

    • Puppy will launch a setup wizard
    • Keyboard layout: Select your layout (US English default)
    • Timezone: Set your timezone
    • Screen resolution: Puppy should auto-detect, but you can adjust if needed
  3. Test the System:

    • Puppy is now running entirely in RAM
    • Test internet connection (wired should work automatically)
    • Explore the desktop
    • Everything works from RAM - nothing is saved yet!

Phase 5: Install to USB (Persistent Storage)

Since you want to use the USB drive permanently:

  1. Click the "Install" icon on the desktop (or Menu → System → Puppy Installer)

  2. Choose installation type:

    • Select "USB Install" or "Frugal Install"
  3. Select target:

    • Choose your USB drive
    • Create a partition if prompted:
      • Use the entire USB drive
      • Format as ext4 (Linux) or FAT32 (if you want Windows compatibility)
      • Recommended: ext4 for better performance
  4. Bootloader installation:

    • Install GRUB bootloader: Yes
    • Location: MBR of USB drive
  5. Save file options:

    • Create a save file or save folder:
      • Save folder (recommended): More flexible, easier to backup
      • Save file: More compatible with some systems
    • Size: Allocate several GB (or leave remainder for general storage)
  6. Complete installation and reboot

Phase 6: Post-Installation Setup

After rebooting from the USB:

  1. First save:

    • When you shut down, Puppy will ask to save your session
    • Choose your save location (the one you created)
    • This saves all changes, settings, and installed programs
  2. Update system (if internet connected):

    • Menu → Setup → Puppy Package Manager
    • Click "Update database"
    • Install any updates
  3. Install additional software:

    • Menu → Setup → Puppy Package Manager
    • Browse and install applications as needed
    • Common additions: LibreOffice, GIMP, VLC, Firefox
  4. Configure WiFi (if needed):

    • Click network icon in system tray
    • Use the network wizard to configure wireless

Important Tips

  • Puppy runs in RAM: Even installed, Puppy loads into your 8GB RAM, making it extremely fast
  • Save regularly: Changes are saved to the USB only when you shut down properly
  • Save sessions: Click "Save" icon periodically to avoid losing work
  • USB wear: ext4 on USB is fine, but avoid excessive writes if possible
  • Backup: Periodically copy your save file/folder to another location

Troubleshooting Boot Issues

If the mini PC won't boot from USB:

  1. Try different USB ports (USB 2.0 ports often more reliable for booting)
  2. Re-check BIOS settings: Ensure Legacy/CSM mode if UEFI fails
  3. Recreate USB using DD mode instead of ISO mode in Rufus
  4. Try Ventoy: Alternative USB boot method (www.ventoy.net)

Your setup should work perfectly with the J4125 processor - it's more than capable for Puppy Linux, which will feel incredibly snappy on that hardware!

Firefox on Puppy Linux

Firefox is definitely available for Puppy Linux, though the approach varies by Puppy version.

Firefox Availability by Puppy Version

FossaPup64 9.5 (Ubuntu 20.04-based)

  • Firefox ESR (Extended Support Release) available through PPM
  • Install via: Menu → Setup → Puppy Package Manager → search "firefox"
  • Typically Firefox ESR 78 or newer
  • Full-featured, stable, receives security updates

BookwormPup64 10.0.x (Debian 12-based)

  • Firefox ESR available from Debian repositories
  • Usually a more recent ESR version (102, 115, or newer)
  • Install same way through Puppy Package Manager

Installation Methods

Method 1: Puppy Package Manager (Recommended)

  1. Open Puppy Package Manager

    • Menu → Setup → Puppy Package Manager
    • Or click the package manager icon
  2. Search for Firefox

    • Type "firefox" in search box
    • Look for "firefox" or "firefox-esr"
  3. Install

    • Select the package
    • Click "Install"
    • PPM will handle all dependencies automatically
    • Takes 2-5 minutes depending on internet speed
  4. Launch

    • Menu → Internet → Firefox
    • Or search in menu for Firefox

Method 2: Official Firefox (Latest Version)

If you want the absolute latest Firefox (not ESR):

Download from Mozilla:

  1. Open terminal and download:

    cd /root
    wget "https://download.mozilla.org/?product=firefox-latest-ssl&os=linux64&lang=en-US" -O firefox.tar.bz2
    
  2. Extract:

    tar -xjf firefox.tar.bz2
    
  3. Create desktop shortcut:

    • Right-click desktop → Create launcher
    • Command: /root/firefox/firefox
    • Name: Firefox
    • Icon: /root/firefox/browser/chrome/icons/default/default128.png
  4. Or move to system location:

    mv firefox /opt/
    ln -s /opt/firefox/firefox /usr/local/bin/firefox
    

Method 3: Flatpak Firefox

If your Puppy has Flatpak enabled:

  1. Install Flatpak (if not already):

    pkg install flatpak
    flatpak remote-add --if-not-exists flathub https://flathub.org/repo/flathub.flatpakrepo
    
  2. Install Firefox:

    flatpak install flathub org.mozilla.firefox
    
  3. Launch:

    flatpak run org.mozilla.firefox
    

Method 4: SFS File (Space-Saving Option)

Some Puppy repositories offer Firefox as an SFS file:

  1. Download Firefox SFS from Puppy forums
  2. Load it: Menu → Setup → SFS Manager
  3. Select your downloaded .sfs file
  4. Load on demand - saves disk space
  5. Firefox appears in menu when SFS is loaded

Firefox vs. Default Browser

Why Firefox Might Be Better Than Default:

Advantages:

  • Better compatibility: More websites work correctly
  • Extensions: Full access to Firefox Add-ons
  • Modern features: Latest web standards support
  • Regular updates: Security patches and features
  • Sync: Firefox Sync across devices
  • Privacy tools: Enhanced tracking protection
  • Developer tools: Better for web development

Default browsers (Pale Moon, Iron, etc.):

  • Lighter weight: Use less RAM
  • Faster startup: On very old hardware
  • Smaller size: Save disk space
  • Good enough for basic browsing

RAM Usage Comparison

On your 8GB system:

  • Pale Moon: ~150-250 MB RAM
  • Firefox ESR: ~300-500 MB RAM (with a few tabs)
  • Firefox (latest): ~400-600 MB RAM
  • Chromium/Chrome: ~500-700 MB RAM

Your 8GB is plenty for Firefox - you'll be fine!

Post-Installation Setup

Essential Firefox Tweaks for Puppy:

  1. Set as default browser:

    • Menu → Setup → Default Applications
    • Select Firefox for web browser
  2. Enable hardware acceleration (for J4125):

    • Firefox → Settings → General
    • Scroll to "Performance"
    • Uncheck "Use recommended performance settings"
    • Check "Use hardware acceleration when available"
  3. Reduce memory usage (optional):

    • Type about:config in address bar
    • Search for browser.sessionhistory.max_entries
    • Change from 50 to 10 (fewer back/forward cache)
    • Search for browser.cache.memory.capacity
    • Set to 51200 (50MB cache)
  4. Install essential extensions:

    • uBlock Origin: Ad/tracker blocking (saves bandwidth)
    • Privacy Badger: Additional privacy protection
    • HTTPS Everywhere: Force secure connections
    • Dark Reader: Dark mode for websites (easier on eyes)

Firefox Profile Location

In Puppy Linux, Firefox stores data at:

  • /root/.mozilla/firefox/ (your profile)

Important for backups: Include this in your save file!

Recommended: Firefox ESR

For Puppy Linux, Firefox ESR is the sweet spot:

Stable: Fewer updates, tested thoroughly
Compatible: Works with Puppy repositories
Lightweight enough: Reasonable RAM usage
Secure: Gets security updates
Full-featured: All Firefox features
Easy updates: Through Puppy Package Manager

Performance Tips

Make Firefox Faster on Puppy:

  1. Disable animations:

    • about:configtoolkit.cosmeticAnimations.enabled → false
  2. Reduce auto-update checks:

    • Settings → General → Firefox Updates → Check for updates but let you choose
  3. Clear cache regularly:

    • Settings → Privacy & Security → Cookies and Site Data → Clear Data
  4. Limit open tabs:

    • With 8GB RAM, you can easily handle 20-30 tabs
    • But fewer tabs = faster performance
  5. Use lightweight theme:

    • Avoid heavy themes/customizations

Troubleshooting

Firefox Won't Start:

  1. Check dependencies:

    ldd /usr/bin/firefox
    
  2. Reset profile:

    firefox -safe-mode
    
  3. Check for conflicts:

    • Remove old Firefox installations
    • Only one version should be installed

Sound Not Working in Firefox:

  1. Check ALSA/PulseAudio:

    • Puppy usually uses ALSA by default
    • Firefox Settings → check audio output device
  2. Test with other apps to confirm sound works in Puppy

Video Performance Issues:

  1. Enable hardware acceleration (see above)
  2. Your J4125 has Intel UHD Graphics 600 - excellent for video
  3. Install video codecs if needed:
    pkg install gstreamer1.0-plugins-good gstreamer1.0-plugins-bad
    

My Recommendation

For your setup (J4125, 8GB RAM, Puppy Linux on USB):

Install Firefox ESR through Puppy Package Manager

Why:

  • ✅ Easiest installation
  • ✅ Automatic updates through PPM
  • ✅ Perfect balance of features and performance
  • ✅ All dependencies handled automatically
  • ✅ Your system can easily handle it
  • ✅ Better website compatibility than lightweight alternatives

You'll have a modern, secure browser that works with everything while still keeping Puppy's legendary speed!

 

Friday, January 2, 2026

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.


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.


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.