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Where are you in your osteoarthritis treatment journey?

And where do you want to go next?

Use this free tool to guide you along the path toward a better life with knee osteoarthritis.

Welcome to OA Compass

Osteoarthritis (OA), also known as degenerative joint disease, is the most common form of arthritis and affects an estimated 360 million people globally.

The good news is that with the right resources and support you can live your best life.

This site is designed to help you or someone you love with knee pain and symptoms of OA better prepare for your next doctor’s visit. You decide where to start to learn more about managing knee osteoarthritis.

This free tool meets you where you are on your knee OA journey — whether you’re just beginning to experience symptoms, have recently been diagnosed, are managing daily life with OA, or are exploring available treatments.

Where will you go from here?

Click on the option that best describes where you are or what you need next on your OA journey.

Select the questions most important to you from the questions that appear below.

Get tips and real-life advice from patients to help guide you toward better joint health.

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Think you might have OA?

Newly diagnosed with OA?

Tips from OA patients

Talking to your doctor about OA

OA treatments

What causes OA?

What are the symptoms of OA?

What are some tips from other patients living with OA?

What are the symptoms of OA?

Osteoarthritis symptoms can range from mild to severe.

Most people first notice knee pain and stiffness after activity, especially when using stairs, walking or hiking, or standing for a while, or when they get up in the morning or after sitting for a long time. Pain worsens with more activity and eases with rest, but often becomes constant, no longer responding to over-the-counter pain relievers, rest, or icing and starting to really limit work and recreation activities.

Symptoms can include:

Pain

Pain is the main symptom of osteoarthritis, usually localized to the affected joint(s).

Stiffness and reduced flexibility

Stiffness and decreased range of joint motion is common, especially after sleeping, sitting, or standing for a while.

Swelling

Joints may feel achy and tender, with swelling increasing after physical activity and as the condition worsens.

Difficulty performing daily activities

The pain, stiffness, and swelling often make work, sport, and recreation difficult.

Bone spurs

Extra bone may form around affected joints.

Instability

Your knee may feel unstable, weak or give out when you put weight on it.

Abnormal alignment

You may start to become bow-legged or knock-kneed.

Slow onset

Osteoarthritis typically develops slowly compared to other joint problems, often taking many years to become debilitating.

Clicking, cracking or grinding sounds

These sounds occur when bones rub together due to lack of cartilage on the joint surfaces.

Asymmetry

Osteoarthritis often becomes symptomatic first in one knee, hip, or shoulder, whereas rheumatoid arthritis typically affects multiple joints on both sides of the body.

Normal lab results

Osteoarthritis is diagnosed through physical exams and diagnostic imaging (X-rays, MRI) with no specific blood test abnormalities related to the OA.

What causes OA?

Osteoarthritis (OA) is primarily caused by the breakdown of cartilage in joints.

Several factors contribute to this process, including:

Aging

Cartilage naturally wears down over time.

Joint Injury

Previous injuries can lead to cartilage damage.

Repetitive Stress

Frequent joint use in certain activities or jobs can accelerate cartilage wear.

Genetics

A family history of OA can increase risk.

Obesity

Extra weight puts additional stress on weight-bearing joints.

Joint Malalignment

Abnormal joint alignment can lead to uneven cartilage wear.

Do other factors put me at risk for developing OA?

Osteoarthritis (OA) in knees typically becomes symptomatic after age 50 but can start earlier due to joint injury or family history. Women are more commonly affected than men. By age 70, most people show some degree of OA in one or more joints, particularly in the hands, neck, spine, hips, and knees. OA worsens over time and has no cure, but treatments can slow its progression, improve joint function, and ease pain. Some of the most effective treatments for OA do not involve surgery or medications, so make sure to talk to a doctor about a comprehensive management plan as soon as you find out you have OA.

What are some tips from other patients living with OA?

Video: Advice from Patients for Anyone Newly Diagnosed with Knee Osteoarthritis

Watch this video to hear knee OA patients share valuable advice for people newly diagnosed with knee OA.

Be aware of your body and when it’s hurting, listen to it.”

– Trish, Florida, OA Patient

Think you might have OA?

Newly diagnosed with OA?

Tips from OA patients

Talking to your doctor about OA

OA treatments

When should I consult a doctor?

What questions should I ask my doctor?

How and why might I track my symptoms?

How and why might I track my symptoms?

Tracking your symptoms is the best way to know how your OA is impacting your life.

When you have an infection like a cold, you know when you have symptoms and when you feel better. But with OA, it is not always so clear-cut to know how you’re doing. Doctors can measure inflammation and do imaging of joints to look for swelling and damage, but this often doesn’t fully capture how patients feel on a daily basis or how their condition is impacting their ability to function and fully live their lives.

What can I do to track my symptoms?

PatientSpot puts your health information in your hands! Track your symptoms, treatments, and other health data from your computer or smartphone.

See how your symptoms are changing – or holding steady – over time. How are you responding to new medications or other changes in treatment?

Click Here to Sign Up

When should I consult a doctor?

Are you experiencing knee pain, even when resting or at night?

The sooner you alert your doctor to your symptoms, the quicker you can get a proper diagnosis and start treatment to manage symptoms and improve your quality of life.

Consult a doctor if you’re experiencing:

Knee pain that persists for more than a week or worsens over time.

Swollen, stiff knees or limited range of motion (especially first thing in the morning or after inactivity).

Difficulty performing daily activities (walking, climbing stairs, standing up from a seated position).

Instability in your knee or your knee gives out when you put weight on it.

A noticeable change in the shape or alignment of your knee such as becoming bow-legged or knock-kneed.

What questions should I ask my doctor?

An important part of shared-decision making is writing down questions for your doctor and bringing them with you to your appointment.

Download the free handout below to help you have a productive conversation with your doctor about your knee osteoarthritis. Write down any additional questions you may have and use the notes sections to jot down information during your visit.

You can use these questions to guide your conversation about symptoms, treatment options, pain management, and lifestyle changes. And, remember, if possible bring a friendly or family member with you to take notes.

Download the Question Guide

OR you can use the questions below to guide your conversation about symptoms, treatment options, pain management, and lifestyle changes. And, remember, if possible bring a friendly or family member with you to take notes.

Click on a topic to see possible some questions you can ask your doctor during your next appointment.

Questions to ask if you’re curious about:

The Basics of Knee OA

What is knee osteoarthritis and what causes it?
What stage of osteoarthritis do I have?
What are the symptoms I should expect?

Getting Diagnosed

What tests or imaging studies do I need to confirm my diagnosis?
How will my condition likely progress over time?

OA Treatments

What are my treatment options?
What are the benefits and risks of each treatment?

Living with Knee OA

What lifestyle changes can I make to help manage my symptoms?
Are there specific exercises or activities I should avoid?
What role does diet play in managing osteoarthritis, and are there specific foods that can help?

Managing Pain

What are the best strategies for managing pain on a daily basis?
Can alternative therapies like physical therapy, acupuncture or chiropractic care be helpful?

Monitoring Your OA

What signs or symptoms should prompt me to contact you between visits?
How can I monitor my condition at home?

What patients say about talking with your doctor:

Video: Trusting and Communicating with Your Doctor

Hear from patient advocate Beverly as she shares what it means to trust and communicate with your doctor, even when the conversations get tough.

It means going to someone that is a professional, has good integrity and saying to them, ‘I’m handing this to you. I’m telling you who I am and what’s going on. I need your help.’”

– Beverly, Indiana, OA Patient

Think you might have OA?

Newly diagnosed with OA?

Tips from OA patients

Talking to your doctor about OA

OA treatments

What are exercises I can do?

How does diet affect OA?

How might OA affect me emotionally or socially?

What are exercises I can do?

Exercise is one of the most effective treatments for osteoarthritis.

Exercise not only helps manage OA symptoms but also benefits your overall health. Regular activities like walking, biking, aerobics, or swimming can help you get to and maintain an ideal weight while keeping your heart healthy and strengthening your bones and muscles. Work with your doctor, physical therapist, and nutrition specialist to find the best and safest diet and exercise regimen for you.

Here are a few tips to help you stay safe and active:

Don’t just “google” a diet and exercise program for OA.

Work with medical professionals to determine a personalized program based on your overall health, resources, and expectations.

Listen to your body.

Avoid exercises that cause more pain or discomfort.

Stay active even during pain flares.

Light movement can help.

Break your exercise routine into consistent shorter segments.

This can help while you build strength and stamina.

Try water exercise, stationary biking, and yoga.

These can be good options when your pain is more noticeable.

Find an exercise you love.

This can be a good way to make exercising fun and keep yourself motivated.

Find an exercise partner or group.

Finding people to keep you accountable can help you stay on track.

How to stay active with knee OA:

Video: Tips for Staying Active

Check out the video for more exercise tips to help you manage knee pain from osteoarthritis.

It doesn’t have to be much—just a walk—some type of low-impact exercise—yoga, swimming.”

– Deen, New Jersey, OA Patient

How does diet affect OA?

There’s no one diet that can fully manage the symptoms of OA.

However, there are a number of safe and easy ways you can tweak your diet to help you increase your energy, maintain a healthy weight, and decrease inflammation. For every pound of unhealthy weight you lose, you reduce the load on your knees and hips by at least 4 pounds, which helps protect your joints and reduces pain.

Here are a few tips to keep in mind:

Seek professional guidance.

Don’t just “google” a diet and exercise program for OA. Work with medical professionals to determine a personalized program based on your overall health, resources, and expectations. Get a referral to a registered dietitian if you need special guidance.

Aim for a variety.

Get a range of colors each day from less processed fruits and vegetables. Frozen produce is a nutritious and affordable option.

Avoid processed foods.

They can increase inflammation and worsen OA symptoms.

Choose whole grains.

Opt for brown rice, whole-grain bread, quinoa, barley, and wheat berries for fiber benefits.

Eat more fruits and vegetables.

They provide antioxidants that fight inflammation.

Include Omega-3s.

Eat fatty fish, like salmon, or take flaxseed to reduce inflammation.

Limit sugar and salt.

Reduce intake to prevent inflammation and swelling.

Set realistic goals.

If you need to lose weight, work with your doctor to develop a weight loss plan that suits you.

Stay hydrated.

Drink plenty of water.

Stick to a sustainable diet.

Follow a healthy eating plan you can maintain for life, rather than a short-term fad diet.

How might OA affect me emotionally or socially?

Being diagnosed with a chronic disease like OA can be overwhelming, leaving you feeling confused, distressed, or even hopeless.

The physical pain can also bring emotional pain, making it hard to go about your daily life and normal activities. It’s natural to feel sad temporarily, but if these feelings last more than a few weeks, they might turn into depression, which needs medical attention.

Symptoms of depression to look out for:

Anxiety

Feelings of sadness or irritation

Emptiness, hopelessness, or worthlessness

Fatigue or decreased energy

Trouble concentrating, remembering, and making decisions

Irregular sleep patterns, either trouble sleeping or sleeping too much

Changes in appetite, such as eating too much or not wanting to eat at all

Thoughts of death or suicide (or suicide attempts)

Aches, pains, cramps, headaches, or digestive problems without a clear physical cause that don’t get better with treatment

Remember, it’s okay to seek help if you notice these symptoms.

You’re not alone, and there are resources and people ready to support you through this.

How do you stay motivated with OA?

Video: Deen Shares How OA Has Impacted Him Physically, Mentally, and Emotionally

Deen went from training for a triathlon to trying to figure out how to move without pain. In this video, he opens up about how this impacted his physical and mental health.

So as long as I’m staying active and just doing something — just to keep my joints moving and active — it’s a win for me.”

– Deen, New Jersey, OA Patient

Think you might have OA?

Newly diagnosed with OA?

Tips from OA patients

Talking to your doctor about OA

OA treatments

What medications are prescribed for OA?

Should I consider surgery?

How can physical and occupational therapy help me?

What medications are prescribed for OA?

Medications are prescribed for OA aim to manage pain and inflammation. Common options include:

Click the plus to expand each type of medication and read more.

NSAIDs

NSAIDS are most commonly used when medications are needed to help treat OA. Non-steroidal anti-inflammatory drugs (NSAIDs) are medications (pills) that can help reduce inflammation, lessen your pain, and help you be more active. There are over-the-counter (OTC) NSAIDs that you can use without a prescription and prescription NSAIDs. They are not steroids, so are generally a safer class of drugs, but still can have side effects and interactions with other medications you may be using, so talk with your doctor to ensure NSAIDs are a safe and effective option for you.

Examples of OTC NSAIDs and pain relievers:

Aspirin
Ibuprofen (Advil)
Naproxen (Aleve)
Acetaminophen (Tylenol)

Examples of Prescription NSAIDs

Celecoxib (Celebrex)
Meloxicam (Mobic)
Ketoprofen (Orudis KT)

What other types of prescription medications may help with pain relief?

Duloxetine (Cymbalta, Drizalma, and Irenka)
Tramadol (Ultram, Ultracet, and Ultram ER (extended release)
Opioids

NOTE: You must consult with your health care team before considering any of these medications for the management of your arthritis.

Intra-articular (IA) Injections

When diet-and-exercise, physical therapy, activity modifications, and medications/supplements are insufficient for managing your OA pain, or when you have a bad “arthritis flare up,” you may want to talk to your doctor about joint (IA) injections. There are currently 3 major types of injections with strong scientific evidence for efficacy for treatment of OA: steroids, hyaluronic acid, and platelet rich plasma.

Here’s why you might consider them:

These injections may quickly reduce pain and inflammation, giving you relief faster than some other treatments.
IA injections are shots that your doctor gives directly into your knee joint. Because the medicine goes straight into your knee joint, it targets the problem area directly.
By reducing pain and swelling, these injections may help you move your knee more easily and comfortably.
The benefits from these injections can last for several weeks to months.
If you prefer not to take pills every day, injections may be a good option to manage your pain.

Steroids

Corticosteroid (steroid) injections can quickly help reduce inflammation, swelling, and pain, making it easier for you to move around and do your daily activities.
The beneficial effects typically do not last more than a couple months, so steroid injections are best used for bad arthritis flare ups
Steroid injections can have detrimental effects on your joint, especially after multiple times, and these injections may affect the timing of joint surgery should you need to choose that option for OA treatment.
Most health insurance policies cover steroid injections.

Hyaluronic Acid (HA)

HA is one of the two natural lubricants in your joint and can also reduce joint inflammation and pain.
The beneficial effects of HA injections typically last 3 to 6 months, and injections can be repeated if effective.
Most health insurance policies cover HA injections, but typically require pre-authorization.

Platelet Rich Plasma (PRP)

PRP is an “orthobiologic” made from your own blood – it requires a blood draw followed by 5-15 minutes processing of the blood in a machine in the exam room you are in. Your PRP can then be injected into your knee as soon as it is ready.
Your platelets in your PRP contain natural chemicals that reduce inflammation and pain, produce joint lubricants, encourage tissue repair, and slow down some of the disease processes of OA.
The beneficial effects of PRP injections typically last 6 to 9 months, and injections can be repeated if effective.
Only a few health insurance policies cover PRP injections at this time, and typically require pre-authorization.

NOTE: Stem cell” injections do not have strong scientific evidence for efficacy for treatment of OA at this time.

Supplements

Make sure that you tell your health care team about any and all supplements that you are taking for any reason as even OTC supplements can have severe side effects and interactions with medications.

Capsaicin (Capzasin P, and Zostrix)
Glucosamine and Chondroitin
Undenatured or Hydrolyzed Collagen type II
Fish oils
Vitamins C, D and E
Methylsulfonylmethane (MSM)
S-Adenosyl-L-methionine (SAMe)
Curcumin
Avocado/Soybean Unsaponifiables (ASUs)

NOTE: Check consumerlab.com before choosing your supplement brand.

Should I consider surgery?

When contemplating surgery, it’s crucial to understand what matters most to you.

According to James Cook, DVM, PhD, OTSC, William & Kathryn Allen Distinguished Chair in Orthopaedic Surgery at the University of Missouri, treatments should align with your priorities, whether it’s pain relief, functionality, or both. Download the free handout below to help you navigate the decision to have knee surgery. Choose which questions are most important to you and bring the handout to your next appointment to write down the answers.

Download the Knee Surgery Question Guide

Other things to think about when considering surgery:

The most common example is people passionate about running. Can we achieve the same fulfillment with swimming or biking? If so, you might delay joint replacement for 10, 15, 20 years. But if running is essential for your happiness, that impacts the decision-making process.”

– Dr. James Cook, Missouri

Click on a topic for more tips on navigating the shared decision-making process.

How can I….

Get ready to talk to my doctor about knee surgery

Consider these points when preparing to talk with your doctor about knee surgery:

Shared decision-making: Discuss treatments you’ve tried and their effectiveness. This helps your doctor understand your unique situation.
Previous treatments: Be ready to discuss past medications, physical therapy, or alternative treatments.
Assessing fit for surgery: Consider your overall health, activity level, and the impact of knee issues on your quality of life.
Bring support: Bring a trusted person to the appointment to help remember information and ask questions.

Have a conversation about knee surgery with my doctor

When discussing knee surgery with your physician, clear communication is key:

Describe your problems: Clearly articulate your symptoms and limitations.
Set goals and expectations: Explain what you hope to achieve from the treatment.
State your purpose: Be clear if you’re seeking a diagnosis, discussing options, or scheduling surgery.

Remember what's important when thinking about knee surgery

Here are a few things to know about knee surgery:

Individualized approach: Each patient’s situation is unique.
Long-term commitment: Surgery requires rehabilitation and lifestyle changes.
Alternative activities: Switching activities, like swimming instead of running, can delay surgery.
Quality of Life: Consider how knee pain affects your daily life and happiness.

How can physical and occupational therapy help me?

Physical therapy (PT) and occupational therapy (OT) can play a role in reducing pain and improving movement.

Therapists create personalized plans to relieve pain and enhance mobility. Starting PT early can slow OA progression and delay or avoid surgery. They focus on knee function, strengthening muscles, and teaching stress-reducing movements. Seeing a therapist early can help you stay active and manage knee OA effectively.

Occupational therapy can benefit people with knee osteoarthritis by teaching them ways to adapt their daily activities and environment to reduce stress on the knees. Therapists provide strategies to manage pain and suggest modifications to the home or workplace, promoting independence and improving quality of life despite knee pain.

Why exercise is important for knee osteoarthritis:

Exercise reduces pain, improves mobility, and maintains joint health. Medications alone often aren’t enough. Combine exercise with weight management, self-management programs, and arthritis education.

Regular exercise helps you:

Maintain a healthy weight

Reduces stress on knee joints

Improve balance

Enhances stability and prevents falls

Strengthen muscles

Provides better knee support

Boost mental health

Improves mood and offers social opportunities

How can I start exercising?

Before you start any exercise routine, it’s essential to consult your doctor.

Here are some tips to get started safely:

Start slowly

Begin with gentle exercises and stop if you feel pain

Stay active daily

Incorporate movement throughout your day with simple activities like walking around the house or doing chores.

Keep exercising

Continue even after symptoms improve to prevent their return

Monitor pain

Seek medical advice if you experience severe pain or changes

What types of exercise can I do?

Focus on low-impact activities that are easy on your joints.

Here are a few examples:

Tai chi

Gentle movements that improve balance and flexibility

Yoga

Helps with strength, flexibility, and stress relief

Swimming

A great-low impact exercise that supports the joints while providing a full-body workout

Try to integrate exercises into your everyday routines. Do some squats while picking up items or stretches while waiting for the microwave. While sitting at a desk, do leg lifts or ankle rotations to keep your joints moving.

Think you might have OA?

Newly diagnosed with OA?

Tips from OA patients

Talking to your doctor about OA

OA treatments

How can I prepare for an appointment?

How can I set goals with my doctor?

What questions should I ask my doctor?

How can I monitor my treatment progress?

How can I prepare for an appointment?

Being prepared for a doctor’s appointment when managing OA is crucial for effective care.

Bringing questions or concerns ensures that you address all aspects of your treatment plan. Preparation also allows for more focused and productive discussions, leading to better-informed decisions about your care and potential adjustments to your treatment. Download your free guide below to help you plan for your next appointment.

Download the Appointment Preparation Guide

How do other OA patients start the conversation?

Video: Collaborating with Your Doctor About a Treatment Plan

In this video, several patients with knee OA share how they considered treatment options and worked jointly with their doctor.

Once I got to the surgeon, I started asking a bunch of questions and being deliberate about my questions. I’m feeling this—what can I do? It opened the door to better dialogue.”

– Deen, New Jersey, OA Patient

How can I set goals with my doctor?

While there’s no cure yet for OA, treatment aims to reduce pain and stiffness, improve joint function, and maintain your ability to perform daily activities and the things you enjoy doing.

Setting clear goals with your doctor is a crucial step in creating an effective management plan. For your initial OA appointment, consider bringing a family member or friend for support. They can help you stay focused on your goals and ensure you fully understand the management plan you and your health care team decide on.

To prepare for your appointment, consider the following steps:

Write down what you will tell the doctor you want from this appointment.

For example, a diagnosis, a second opinion, an explanation of the problems and prognosis, treatment options, and/or a referral to a specific specialist.

Write down your goals and expectations and prioritize them.

Write down 3-4 key questions that you have about OA.

Don't be afraid to get a second opinion.

Before you make any treatment decisions, you can get input from an additional specialist.

Here are some examples of goals you might set with your health care team:

I want to be able to…

Safely perform activities of daily living

For example: getting out of bed, getting in and out of shower/bath, housework, shopping, etc.

Return to work

Play with children or grandchildren

Do the things I enjoy

For example: gardening, yard work, hiking, dancing, etc.

Do recreational activities and sports

Enjoy an evening out with friends and family

Reach and maintain a healthy weight

Stick to my medication plan

Manage medication side effects

Achieve target medication dosages

Use medication reminders to track medication usage and progress

What one doctor wants you to know about setting treatment goals:

Video: Dr. James Cook Discusses Personalized Decision-Making for Knee OA Surgery Timing and Options

Listen in as Dr. James Cook, Director of Operations and Research, Orthopaedic Surgery, discusses the importance of personalized decision-making in treating knee osteoarthritis.

Some people say ‘If I can’t run, I’m not happy, it’s ruining my quality of life’ and that’s part of the decision-making process. It has to be patient-specific and we have to listen.”

– Dr. James Cook, Missouri

What questions should I ask my doctor?

An important part of shared-decision making is writing down questions for your doctor and bringing them with you to your appointment.

Download the Question Guide

Click on a topic to see possible some questions you can ask your doctor during your next appointment.

Questions to ask if you’re curious about:

The Basics of Knee OA

What is knee osteoarthritis and what causes it?
What stage of osteoarthritis do I have?
What are the symptoms I should expect?

Getting Diagnosed

What tests or imaging studies do I need to confirm my diagnosis?
How will my condition likely progress over time?

OA Treatments

What are my treatment options?
What are the benefits and risks of each treatment?

Living with Knee OA

What lifestyle changes can I make to help manage my symptoms?
Are there specific exercises or activities I should avoid?
What role does diet play in managing osteoarthritis, and are there specific foods that can help?

Managing Pain

What are the best strategies for managing pain on a daily basis?
Can alternative therapies like physical therapy, acupuncture, or chiropractic care be helpful?

Monitoring Your OA

What signs or symptoms should prompt me to contact you between visits?
How can I monitor my condition at home?

How can I monitor my treatment progress?

A big part of managing OA is managing the trial-and-error process of finding the right medications to treat your disease.

Because OA is progressive — and the immune system is mysterious — not all medications work equally well for all patients. Commonly, medications may work for a period of time and then fail to continue to provide relief or control disease activity.

If you’re about to start a new medication, here are some questions you may want to ask your doctor:

Why am I taking this medication — how is it expected to help me feel better?

How soon should the medication start working?

How will you monitor whether or not it is working?

What side effects should I watch out for?

What long-term side effects or risks should I be aware of?

Why do the benefits of taking this medication outweigh the risks for me?

Does this medication interact with any other drugs or supplements I use?

How often do I take this medication? What is the dose?

Are there any other tips I should know about using this medication safely?

Is there anything I need to avoid eating, drinking, or doing while taking this medication?

Is there anything I can do to help manage potential side effects?

If I have a concern or question about this medication, who should I call?

What patients say about tracking knee pain:

What I do on a regular basis is notice when I’m having pain and what that pain is and I keep a notebook and I document it.”

– Beverly, Indiana, OA Patient

Everyone needs to get a knee notebook. You need to be able to communicate to your doctor so they know the severity.”

– Tien, Pennsylvania, OA Patient

PatientSpot puts your health information in your hands! Track your symptoms, treatments, and other health data from your computer or smartphone.

See how your symptoms are changing – or holding steady – over time. How are you responding to new medications or other changes in treatment?

Click Here to Sign Up

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A one-page overview of OA to consult during your appointment

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The information contained on the Global Healthy Living Foundation (GHLF) website is provided for general information purposes only. GHLF does not give medical advice or engage in the practice of medicine. The organization under no circumstances recommends any particular treatment for specific individuals and in all cases recommends that you consult your physician before pursuing any course of treatment. This recommendation stands for pharmacological and non- pharmacological treatment considerations.