Just before Christmas last year, a 77-year-old woman named Nancy Hammer* walked into her family doctor's office with worsening back pain. She walked out with two prescriptions: an opioid, and a drug called gabapentin.
She is not alone. Gabapentin — brand names Neurontin, Horizant — is now the seventh most prescribed drug in the United States, with roughly 15.5 million people receiving it annually. In Canada, the numbers tell a similar story. It has become the go-to prescription for back pain, nerve pain, anxiety, migraines, hot flashes, and insomnia. One doctor even noted it is prescribed to calm cats and dogs.
A landmark Wall Street Journal investigation published in December 2025 asked a question that should concern every patient and every clinician: Is gabapentin actually safe?
The answer, increasingly, is no.
How We Got Here
Gabapentin was approved decades ago for seizures and the nerve pain that follows shingles. It was never designed for chronic back pain. But when the opioid crisis forced physicians to reconsider their prescribing habits, gabapentin stepped in to fill the void. It was presented as a safer, non-addictive alternative.
That framing turned out to be wrong.
What the Research Now Shows
Growing evidence is challenging gabapentin’s reputation as a benign drug:
- Dementia risk. Research has linked gabapentin use to a higher risk of dementia — a finding with serious implications for older patients who are already the most frequent recipients of back pain prescriptions.
- Suicidal behaviour. Studies have tied the drug to increased risk of suicidal ideation and behaviour.
- Dangerous breathing problems. In people with lung disease — including smokers and those with COPD — gabapentin can cause severe respiratory complications. Combined with opioids, the risk is dramatically amplified. Research shows that co-prescribing gabapentin with opioids nearly doubles the odds of opioid-related death, with high-dose gabapentin increasing that risk by close to 60%.
- It doesn’t even work that well. A study published this year found that giving gabapentin to surgical patients did nothing to shorten hospital stays or reduce complications — and more of those patients reported pain four months after surgery than those who did not receive it. Surgeons had promoted the drug as a way to reduce opioid dependence after procedures. The evidence no longer supports that.
Important: At least 5,000 people per year are now dying in overdoses that involve gabapentin, frequently in combination with opioids — the same combination that Nancy Hammer was sent home with.
“It Seemed Harmless”
Those three words, spoken by a patient quoted in the WSJ investigation, capture exactly how gabapentin earned its reputation. It wasn’t backed by robust evidence for most of the conditions it’s prescribed for. It was backed by familiarity, habit, and the urgent need to prescribe something that wasn’t an opioid.
Medical examiners began noticing gabapentin appearing with increasing frequency in overdose autopsies. One county examiner in Ohio, who went on to co-author a CDC warning report in 2022, described his concern plainly:
“It was just such a bad idea to ever reach into using opioids for chronic pain. What concerned me about seeing gabapentin was, is this just another chapter of this idea?”
— County Medical Examiner, Ohio (cited in Wall Street Journal, December 2025)It is.
What This Means for Back Pain Patients
Back pain is the most common reason Canadians visit a healthcare provider. The majority of cases — including disc herniations, facet syndrome, degenerative disc disease, and muscle or ligament injuries — respond well to conservative care. The evidence for that has been consistent and compelling for decades.
The problem is that conservative care takes time, effort, and patient commitment. A prescription takes 30 seconds to write.
In over 40 years of clinical practice, I have seen patients arrive at our clinic after months or years on medications that were never well-suited to their condition. Some had been on gabapentin for back pain without anyone revisiting whether it was still appropriate — or whether it had ever been. Some were on gabapentin and an opioid simultaneously, unknowingly carrying a combination now recognized as a significant mortality risk.
A Better Path
At Woodbridge Rehabilitation Centre, our approach to back pain is grounded in the same evidence the Wall Street Journal investigation is now pointing the broader public toward: active rehabilitation works, and it works without the risks that come with long-term pharmaceutical management.
For most patients with acute or chronic back pain, the clinical evidence supports:
- Spinal manipulation and mobilization — with one of the strongest safety profiles of any intervention in musculoskeletal care
- Active rehabilitation — progressive exercise, postural retraining, functional restoration
- Soft tissue therapies — addressing the muscular and fascial contributors to pain
- Patient education — understanding your condition reduces fear, reduces catastrophizing, and improves outcomes
These aren’t alternatives to medicine as a last resort. They are first-line interventions supported by clinical guidelines, including those from the CDC itself.
The Bottom Line
If you or someone you care about has been prescribed gabapentin for back pain — particularly alongside an opioid — it is worth having a direct conversation with your prescribing physician about the current evidence. Ask whether the prescription is still appropriate. Ask about the risks. Ask whether active rehabilitation has been fully explored.
You deserve a complete answer.
If you are looking for a conservative, evidence-based approach to back pain that does not begin and end with a prescription, we are here.
*Name has been changed. This article is for informational purposes only and does not constitute medical advice. Always consult your physician before making any changes to your medications or treatment plan.