Pain is personal and highly subjective. An event that causes excruciating, intolerable agony for one person might be perceived by another as distressing but bearable. Even the same person may have a different experience of their pain from one day to the next.

That is why doctors and nurses ask patients about their pain. There is no technology that can assess it. Researchers studying pain must rely on the individual’s report.

That may help explain why developing pain medications has been so difficult. Opioids work well for most people to alleviate acute pain. But some people report intolerable digestive tract side effects.

Over a longer term, such drugs may become less effective. As a result, people may need larger amounts to get the same relief. Of course, higher doses bring a greater risk of side effects as well. The epidemic of overdose deaths this country has seen has discouraged prescribers from offering opioids for pain relief.

People are still seeking help for their pain, however. What analgesics are they receiving?

One choice that is surprisingly popular with physicians is gabapentin. It is the most prescribed medicine for pain in America and has been in the top 10 of all drugs prescribed in the U.S. The official prescribing information says it can be used for post-herpetic neuralgia (lingering pain after shingles) or epileptic seizures.

Although it hasn’t been approved to treat chronic pain other than that following shingles, many people take it for a range of pain problems. One reason, perhaps, is that gabapentin is not a scheduled drug. Prescribing it does not require the same precautions that must be used when prescribing an opioid. Is that wise?

An investigation published in the Wall Street Journal suggests that it is neither as safe nor as effective as patients have been told. One disturbing side effect that most would not expect is cognitive dysfunction.

An analysis of patient records covering 20 years covered 26,416 adults with chronic lower-back pain (Regional Anesthesia & Pain Medicine, July 10, 2025). Those who filled at least six prescriptions for gabapentin were more likely to develop mild cognitive impairment or even dementia. That chance was higher with 12 or more prescriptions. The risk was most pronounced among younger people, those under 65, who were twice as likely to have cognitive problems as those who got fewer than six gabapentin prescriptions. With so many gabapentin prescriptions dispensed, we could be looking at a serious public health problem.

Another popular prescription to treat pain is also having its reputation revised. A systematic review published last year found that tramadol is possibly helpful for pain relief but probably increases the risk of both serious and non-serious side effects (BMJ Evidence-Based Medicine, Oct. 7, 2025).

Why worry about tramadol? It is also used when a clinician believes that an opioid would not be appropriate. When the drug was first introduced, prescribers were assured that it was not habit-forming. However, many people find that stopping tramadol suddenly can lead to anxiety, brain zaps, sweating, tremors, headaches, nausea, depression and aggressiveness.

There is no perfect pain reliever for everyone. Just as pain is highly individual, so too is the treatment of pain. Finding the best strategy requires a dedicated pain team to manage this complex problem so patients do not need to suffer.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”