Medications, Gabapentin,
Musculoskeletal Pain,
and Chiropractic Care

Americans spend a substantial amount on pharmaceuticals (prescription drugs) each year. In 2024, total prescription drug expenditures were approximately $806 billion, up 10.2% from 2023 (1). An additional $43 billion is spent yearly for over-the-counter drugs (2).

Americans spend approximately $35 billion annually on pain medicines, encompassing both over-the-counter (OTC) and prescription pain management drugs (3).

George W. Bush was President of the United States from January 20, 2001, to January 20, 2009, two terms, making him the 43rd President of the United States. During his first term, in 2003, President Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). This meant that Medicare, our government’s health program for seniors, began paying for drugs for Americans over the age of 65 years. This program is commonly known as Medicare Part D.

A search using the AI tool grok.com with the question “How Much Does Medicare Pay for Senior Drugs Yearly?” generated this (edited) reply (4):

Total Medicare Spending on Prescription Drugs

• In 2023, national Medicare Part D prescription drug spending reached about $450 billion.
• Medicare Part D spending has grown significantly; from 2014–2022, it increased at an average annual rate of 8.9%.
• Exact total Part D expenditures for 2024 or 2025 are not yet finalized, but projections indicate continued growth due to enrollment and drug utilization.

Average Spending Per Enrollee (Per Senior)

• Medicare Part D has about 50–55 million enrollees (mostly seniors age 65+).
• Historical averages for gross drug spending per enrollee are around $2,000–$3,000 annually.

John Abramson, MD, was a family physician for 22 years. He has now been on the faculty at Harvard Medical School for 29 years. In 2022 he authored the book (5):

Sickening
How Big Pharma Broke American Health Care

In this publication, Dr. Abramson details how the pharmacology companies have taken over control of healthcare in our country.

Marty Makary, MD, is a surgeon and public health researcher. Prior to being selected as the 27th commissioner of The Food and Drug Administration (FDA) in 2025, he served as a professor at Johns Hopkins School of Medicine. To date, he has 396 citations identified using a PubMed search of the National Library of Medicine. In 2024 he authored the book (6):

Blind Spots
When Medicine Gets it Wrong and What It Means for Our Health

In this publication, Dr. Makary notes that the American Health Care System costs $4.5 trillion yearly. 

On December 23, 2025, the newspaper The Wall Street Journal, published a study titled (7):

America’s Seniors Are Overmedicated

One in Six Seniors Enrolled in Medicare’s Drug Benefit Were Prescribed Eight or More Medications at the Same Time

The article also notes (7):

• 6 million American citizens are simultaneously prescribed 8 or more medications.
• 9 million American senior citizens were prescribed 10 or more drugs at the same time.
• 419,000 American senior citizens were prescribed 15 or more drugs at the same time.
• The article notes that one of the more abused drugs taken by these senior citizens and paid for by Medicare Part D is gabapentin, usually prescribed for chronic back pain.

Three days later, on December 26, 2025, The Wall Street Journal published a follow-up article titled (8):

The Hidden Risks of America’s Most Popular Prescription
Painkiller Gabapentin has Soared in Popularity
as an Alternative to Opioids,
but Patients are Finding it Can Cause Harm

The Wall Street Journal
December 26, 2025; pp. A1 and A10

Summary points from this publication include:

John was just back from a guys’ golfing weekend and doing dead lifts at the gym in 2023 when he felt a pop in his lower back. A disc had slipped and was pressing on a nerve. 

After months of rest, physical therapy, and steroids, he was prescribed a drug called gabapentin by a pain management specialist who told John that it could help calm his nerve pain and that it was “nonaddictive.”

He took the medicine for a few days, then had surgery, and took it again for a little more than three weeks.

The 33-year-old former high-school physical education teacher said he experienced a severe protracted withdrawal when he stopped, which led to neurological symptoms now that make his original back problem seem like “a paper cut” by comparison.

John lies in a dark room at his mother’s home. His wife visits every day or two.

His symptoms include shaking and a burning sensation throughout his body, muscle spasms, and a racing pulse. He can’t sleep for more than a half-hour at a time and has lost so much weight that his wife said his calves are the size of her arms. The change in his life, he said, is “beyond dramatic.”

Approved by the Food and Drug Administration decades ago for seizures and nerve pain from shingles, gabapentin is now the seventh-most widely prescribed drug in the U.S. About 15.5 million people were prescribed gabapentin in 2024.

Studies show that most of the prescriptions are written to treat conditions that it wasn’t approved for—a practice that is legal and common, but means the FDA hasn’t vetted its risks and benefits for those purposes.

A growing body of research shows it isn’t as safe or effective as doctors have long thought. Gabapentin has been associated in studies with greater risk of dementia, suicidal behavior, severe breathing problems for people who have lung disease, and edema, in addition to well-known side effects like dizziness.

Giving gabapentin to surgery patients didn’t reduce complications or get them out of the hospital any faster, and more of them reported pain four months after surgery. Doctors for years had touted gabapentin as a way to use fewer opioids.

While the medical establishment has mostly maintained that gabapentin isn’t habit-forming, some patients have reported debilitating adverse effects when they try to taper off it. They say the withdrawal symptoms make it clear to them they have developed a dependence to the drug taking it as prescribed.

Gabapentin prescriptions have more than doubled over the past 15 years.

At least 5,000 people have died from gabapentin-involved overdoses in each of the past five years.

For John, neither the pain management specialist who prescribed him the medication nor a specialist he saw after surgery told him about adverse effects gabapentin might have or that he might need to taper off it. The pain management specialist told him that gabapentin couldn’t possibly be the cause of his symptoms.

Several other doctors have since told him that gabapentin is likely the cause of his condition, including a neuropsychiatrist who diagnosed him with severe dysautonomia, or impairment of the autonomic nervous system. 

“I thought it was harmless,” he said of the drug. Had he known the risks and that he should reduce his dose gradually when stopping it, John said, “I never would have taken it.” “I cannot function.”

The majority of patients prescribed gabapentin are over age 65. More than 90% of Medicare beneficiaries who received gabapentin within a month of a reported visit with the prescribing doctor got it for an off-label use.

Gabapentin was approved by the FDA in 1993 under the brand name Neurontin to help treat partial seizures.

Warner-Lambert and Pfizer amplified the positive findings to doctors through sales calls and “continuing medical education” seminars that drew thousands of physicians, as well as a publication strategy focused on pushing positive articles about gabapentin in medical journals and suppressing negative data, including about harms, according to a review of legal documents, scientific studies, and interviews with doctors and researchers. Potential adverse events the companies knew about included depression, suicidal ideation, somnolence, edema, dizziness, and confusion, documents from lawsuits show. 

One Pfizer medical director referred to the drug as the “‘snake oil’ of the twentieth century” in an email later made public. The drug’s sales grew from almost $98 million in 1995 to more than $2 billion in 2003.

The Pfizer unit responsible for gabapentin ultimately pleaded guilty to criminal wrongdoing and was fined $430 million in 2004 for illegally promoting Neurontin’s off-label use to doctors. It was one of the largest Medicaid-fraud settlements at the time, and the case led to calls for new marketing standards for pharmaceuticals.

Kaiser Foundation successfully sued Pfizer over its Neurontin marketing practices and was awarded $142 million in 2010.

••••

In January 2023, a review of the literature, citing 72 references, pertaining to gabapentin was published in the journal Pain Practice, titled (9):

Gabapentin—Friend or Foe?

The authors note:

• “Gabapentin is a recommended first-line agent for treating neuropathic pain; however, its efficacy rate is reportedly low, and the risk of adverse events is high.”
• Gabapentin was approved by the Food and Drug Administration (FDA) in 2002.
• Gabapentin is often used as a substitution for opioids, but “there is no clear evidence that this is a medically effective policy.”
• Gabapentin has a significant side effect profile that includes dry mouth, nausea, altered bowel function, altered behavior, product abuse and misuse.
• “[Gabapentin] is not as effective as initially thought, and there has been little discussion as to why the response rate for major neuropathic pain relief is rather low.”
• Studies have shown that patients treated with gabapentin will not derive meaningful pain relief but will likely experience adverse events.
• “There is insufficient data to support use in unapproved pain conditions, such as chronic low back pain and sciatica.”
• A large portion of gabapentin use is off-label.
• “Excessive Off-label prescription Gabapentinoid use more than tripled in the USA between 2002 and 2015 and continues to rise.”
• “An investigation of prescribing practices in the USA found that 83% of gabapentin prescribing was off-label.”
• “This has been driven partly by alleged aggressive promotion of off-label use for pain by the manufacturer, and biased reporting of questionable trials for off-label use.”
• Gabapentin has become a popular alternative to opioids for pain and is widely recommended as a first-line agent for the treatment of neuropathic pain, despite limited supporting evidence and safety concerns.
• Concomitant use with opioids significantly increases the risk of fatal opioid overdose, likely due to exacerbated respiratory depression.
• Gabapentin’s efficacy is lost over time.
• Gabapentin’s clinical use should be reconsidered until there is evidence that it is doing more good than harm.
• “[The authors] caution against leaving patients with high neuropathic pain levels on long-term gabapentin as more harm than good may be occurring.”

••••

Also in 2023, an important study was published in the journal BMJ Open, titled (10):

Association Between Chiropractic Spinal Manipulation
and Gabapentin Prescription in Adults with Radicular Low Back Pain:
Retrospective Cohort Study Using US Data

This study was the first to examine the association between chiropractic spinal manipulative therapy (CSMT) and the likelihood of gabapentin prescription among patients with radicular low back pain (rLBP). Participants were adults aged 18–49 who were having their first episode of rLBP diagnosis. Their mean age was 36 years, and 60% were women. The authors note that the radicular pain was neuropathic pain.

The age bracket of adults under 50 was selected for this study because rLBP is more likely to result from lumbar disc herniation in patients of this age, while older patients are more likely to have lumbar stenosis underlying rLBP. The natural history of rLBP is that it typically improves over a span of 3 months to 1 year.

Eligible patients were from 77 healthcare organizations:

• There were 1,635 patients in the CSMT cohort.
• There were 1,635 patients in the gabapentin cohort.

The authors note:

• “The USA has the leading age-standardized prevalence of low back pain (LBP) in the world.”
• “Together, low back and neck pain account for the leading cause of medical expenditures in the USA.”
• “Radicular low back pain (rLBP), which involves a nerve root lesion, is considered a type of neuropathic pain, and involves radiating symptoms into the ipsilateral lower extremity.”
• “Radicular low back pain (rLBP) is often treated off-label with gabapentin or by chiropractors using chiropractic spinal manipulative therapy (CSMT).” [bold added for emphasis]
• “Gabapentin has been used off-label to treat neuropathic symptoms of LBP, namely rLBP.”
• Gabapentin has had US Food and Drug Administration (FDA) approval for use in neuropathic pain conditions since 1993.
• Systematic reviews in 2018 and 2022 have demonstrated clear evidence of gabapentin’s lack of effectiveness for rLBP.
• There is growing evidence of risks associated with gabapentin use, including abuse, misuse, dependence, and withdrawal. Other deleterious adverse effects of gabapentin include somnolence (excessive sleepiness), dizziness, ataxia, fatigue, and new-onset asthenic (weakness or lack of energy) symptoms.
• “Several clinical practice guidelines do not recommend gabapentin for the treatment of LBP or rLBP, including those of the American Family Physician.”
• “Gabapentin prescription for LBP has been described as a marker of low-value care and medical overuse.”
• “Despite the paucity of evidence, and in contrast to clinical guideline recommendations, gabapentin continues to be commonly prescribed for LBP.”
• “Chiropractors are portal-of-entry providers in the USA who frequently treat spinal disorders.”
• “When treating rLBP, these providers often use chiropractic spinal manipulative therapy (CSMT), a hands-on treatment directed to the joints of the spine.”
• CSMT is supported by systematic reviews and recommended by clinical practice guidelines for the treatment of LBP and rLBP.

Findings:

• “Gabapentin prescription was less frequent in the CSMT cohort over the 1-year follow-up after rLBP diagnosis.”
• “After matching, odds of gabapentin prescription over the 1-year follow-up were significantly lower in the CSMT cohort compared with the cohort receiving usual medical care,” by 47%.

Conclusions:

• “These real-world findings support our hypothesis that adults initially receiving CSMT for rLBP have reduced odds of receiving a gabapentin prescription over a 1-year follow-up period.”
• “Our findings are similar to those of previous studies which demonstrated an association between initial receipt of CSMT and reduced odds of prescription of opioids and benzodiazepines.”
• “Our findings add to growing evidence that receipt of CSMT early in the care pathway for new onset LBP/rLBP could lead to greater concordance with these guidelines with respect to medication prescribing practices.”
• “Our findings are consistent with some authors’ recommendations that patients with LBP/rLBP should initiate treatment with non-pharmacological providers such as chiropractors.”
• “This large retrospective cohort study found that adults receiving CSMT for a new diagnosis of rLBP have significantly reduced odds of receiving a gabapentin prescription over 1-year follow-up compared with those receiving usual medical care.”
• “Gabapentin, opioids and benzodiazepines are… not recommended by several clinical practice guidelines for acute LBP/rLBP.”
• Gabapentin carries a “risk of abuse, misuse, dependence, withdrawal and adverse events.”
• Explanations as to why initial CSMT for rLBP could be associated with a reduction in gabapentin prescription include: “While US chiropractors are portal-of-entry providers, they do not prescribe medications, including gabapentin.”
• “Considering that previous randomised controlled trials have found that CSMT is effective in alleviating LBP and rLBP, it remains possible that pain relief afforded by CSMT accounts for the observed reduction in gabapentin prescription.”
• “[A] previous study found that patients who received CSMT for LBP had significantly reduced odds of having an adverse drug reaction suggesting that reduced prescription of medications used to treat pain could translate into less adverse events.”

••••

In 2025, a study published in the journal Regional Anesthesia & Pain Medicine, titled (11):

Risk of Dementia Following Gabapentin Prescription
in Chronic Low Back Pain Patients

This study examined whether gabapentin prescriptions are associated with dementia in adults with chronic low back pain. It is a retrospective cohort study of 26,416 adults. The primary outcome was the occurrence of dementia, including vascular dementia, dementia in other diseases, unspecified dementia, and Alzheimer’s disease. Subjects were followed for a period of 10 years. The chronic back pain syndromes included lumbar radiculopathy. The authors note:

• Gabapentin was approved in 1993 to treat seizures and has been used for the treatment of chronic pain for over 20 years.
• “Gabapentin is a common treatment for chronic pain, and its increasing use has prompted further investigation into its adverse effects.” The most common side effects from gabapentin include sedation, dizziness, gait instability, and somnolence.
• Gabapentin is widely used to treat chronic pain.
• “Studies have associated gabapentin with cognitive decline and risk of exacerbation for patients with chronic obstructive pulmonary disease (COPD).”

Findings from this study:

• “Our initial analysis yielded an increased risk of dementia in adults (age >18) in the gabapentin cohort compared with the no gabapentin cohort.”
• “Among non-elderly patients (age 18–64), gabapentin prescription was associated with a greater likelihood of dementia compared with those not prescribed gabapentin.”
• “When comparing varying frequencies of gabapentin prescriptions (≥12 vs 3–11 prescriptions) in adults, we observed elevated risk for both dementia and MCI [mild cognitive impairment] in the higher prescriptions group.”
• “Patients with six or more gabapentin prescriptions had an increased incidence of dementia by 29%.”
• Patients with six or more gabapentin prescriptions had an increased incidence of mild cognitive impairment by 85%.
• “Non-elderly adults (18–64) prescribed gabapentin had over twice the risk of dementia (110%) and mild cognitive impairment (150%) compared to those not prescribed gabapentin.”

Conclusions:

• “Gabapentin prescription in adults with chronic low back pain is associated with increased risk of dementia and cognitive impairment, particularly in non-elderly adults.”
• “Our findings indicate an association between gabapentin prescription and dementia or cognitive impairment.”
• “Increased gabapentin prescription frequency correlated with dementia incidence.”
• “Chronic gabapentin exposure has also been linked to reduced neurogenesis and synaptic plasticity in memory-related brain regions.”
• “The current study adds evidence of an important association, as we discovered that gabapentin prescription increases the risk of dementia and cognitive impairment for adult patients with chronic low back pain.”
• “The findings of this study support the need for close monitoring in adult patients prescribed gabapentin to assess for potential cognitive decline.”

Concluding Remarks

The primary reason patients seek chiropractic care is for the management of chronic low back pain (12). Chiropractors do not prescribe drugs. Chiropractors provide mechanical-based (specific line-of-drive spinal manipulation) care that is proven to be both safe and effective for back pain.

In contrast, drug management of low back pain is problematic on many levels. The current escalation of the use of gabapentin is especially concerning. This publication reviews that it does not work very well for back pain and is associated with many serious adverse effects.

This publication shows that chiropractic care can significantly reduce the use of gabapentin.

REFERENCES:

1. grok.com; How much do Americans spend on pharmacology yearly?; January 1, 2026.
2. grok.com; How much do Americans spend on OCT drugs yearly?; January 1, 2026.
3. grok.com; How much do Americans spend yearly on pain medicine?; January 1, 2026.
4. grok.com; How much does Medicare pay for senior drugs yearly?; December 30, 2025.
5. Abramson J; Sickening: How Big Pharma Broke American Health Care; Marinar Books; 2022.
6. Makary M; Blind Spots: When Medicine Gets it Wrong and What It Means for Our Health; Bloomsbury Publications; 2024.
7. __________; America’s Seniors Are Overmedicated: One in six seniors enrolled in Medicare’s drug benefit were prescribed eight or more medications at the same time; The Wall Street Journal; December 23, 2025; p. A10.
8. McKay B, Ramachandran S; Hidden Risks of a Popular Prescription Painkiller:  Patients Struggle with Gabapentin; The Wall Street Journal; December 26, 2025; pp. A1 and A10.
9. Russo M, Graham B, Santarelli DM; Gabapentin—Friend or Foe?; Pain Practice January 2023; Vol. 23; No. 1; pp. 63-69.
10. Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA; Association Between Chiropractic Spinal Manipulation and Gabapentin Prescription in Adults with Radicular Low Back Pain: Retrospective Cohort Study Using US Data; BMJ Open; July 21, 2023; Vol. 13; No. 7; e073258.
11. Eghrari NB, Yazji IH, Yavari B, Van Acker GM, Kim CH; Risk of Dementia Following Gabapentin Prescription in Chronic Low Back Pain Patients; Regional Anesthesia & Pain Medicine; July 10, 2025; epub.
12. Adams J, Peng W, Cramer H, Sundberg T, Moore C; The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults; Results From the 2012 National Health Interview Survey; Spine; December 1, 2017; Vol. 42; No. 23; pp. 1810–1816.

“Authored by Dan Murphy, D.C. Published by ChiroTrust^® – This publication is not meant to offer treatment advice or protocols. Cited material is not necessarily the opinion of the author or publisher.”