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[7] [27] A thorough assessment should include screening for contraindications such as personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2

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When Tramadol May Be Appropriate: If your doctor determines tramadol is necessary for moderate pain, they may: Start with the lowest effective dose Monitor closely for gastrointestinal side effects Provide anti-emetic medication if needed Schedule regular reviews to assess ongoing necessity Consider modified-release formulations to minimise peak-related side effects Alternative Approaches: Depending on your pain condition, non-pharmacological strategies may complement or reduce medication needs: Physical therapy and exercise programmes Cognitive behavioural therapy (CBT) for chronic pain Topical treatments (NSAIDs gels, capsaicin cream) for localised pain TENS machines for certain pain types When to Seek Medical Advice: Contact your GP or healthcare provider if you experience: Severe or persistent nausea and vomiting preventing adequate nutrition or hydration Severe abdominal pain, particularly if accompanied by vomiting Signs of pancreatitis (severe, persistent upper abdominal pain vomiting)stop semaglutide and seek urgent medical assessment Inadequate pain control with current medication Side effects affecting your quality of life or medication adherence NICE guidance (NG193) emphasises individualised pain management and regular medication reviews

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