Which of the following statements is true regarding the use of tramadol?

Tramadol is classified as a centrally acting analgesic with both opioid and non-opioid mechanisms. While it does have opioid-like effects, it is not considered a fully opioid medication. It acts on the mu-opioid receptors and inhibits the reuptake of serotonin and norepinephrine, which contributes to its analgesic efficacy.

Physical dependence on tramadol can occur, particularly with long-term use. This is because, although it is a weaker opioid, prolonged exposure to tramadol can lead to changes in the brain's chemistry and the development of tolerance, resulting in physical dependence. When a user who has developed dependence stops taking tramadol suddenly, withdrawal symptoms may emerge, underscoring the potential for physical dependence.

In contrast, tramadol should not be taken with alcohol, as this combination can pose significant risks, including respiratory depression and increased sedation. Additionally, while tramadol does have side effects, such as nausea, dizziness, and drowsiness, to claim it has "no side effects" is inaccurate.