Hen I wasn't sure if it was the medication...other

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Some participants implied they tried not to rely on medication for managing their AS because of the many sideeffects Til now, it has not been clear {whether|whether or not knowledgeable. It just comes on you..." whereas an additional participant implied "I never discovered that I was tired usually, only after a flare up." Function commitments had been on one hand viewed as a motivator for life, one participant mentioned "it [job] keeps me going", but alternatively a further participant who finished perform as a consequence of fatigue in AS stated "I have finished operate now so I am managing a great deal much better, but when I was operating I found it very hard, you can just cry or you felt physically sick since you felt so tired." In agreement one particular participant stated "In the end I just gave up perform...it created it much easier physically not obtaining to go in, but I still discover I'm possessing periods of mood swings and depression...the longer it [sleep problems] goes on then the extra mood swings kick in." Yet another participant located it "hard to concentrate in perform for the reason that you felt so tired." There was a common consensus more than the uncertainty of irrespective of whether the symptoms of AS (such as discomfort, impaired sleep) brought on fatigue or if fatigue was a symptom of AS. 1 participant questioned "Has the humira [adalimumab] helped me using the fatigue or has it helped with my sleeping pattern which has indirectly helped with my fatigue?". The following theme highlights self-management interventions utilised by participants including experiences and challenges. (2)Current limitations (of self-management) Participants have been encouraged within the focus group to talk about what interventions or remedies they had tried, or wanted to try with regard to self-managing their fatigue. Responses ranged from; obtaining a good attitude "just retain on going" and "trying to find out the glass half complete not half empty", self-medication "I will take a lot more co-codamol",Davies et al. BMC Musculoskeletal Issues 2013, 14:163 http://www.biomedcentral.com/1471-2474/14/Page four ofkeeping active "every day I walk to get a superior hour with all the dogs, I swim and I preserve active", and being a member of a gym. Hydrotherapy was a common activity, but getting a warm pool and the price involved were viewed as problematic "it could be lovely to swim in a warm pool however the costs these locations are charging." 1 participant stated they felt they "had to workout that was the leveller.....if I do not do it [exercise] I am in actual problems." Other participants reported sleeping for short periods of time "a 10 minute power nap and I am fine again". Some participants implied they attempted not to rely on medication for managing their AS due to the several sideeffects skilled. The following quote illustrates this predicament: "I was taking indomethacin for the pain however it triggered the bowel to flare up and I was hospitalised with that....so I try and manage without the need of drugs if I can...but naturally you will need to in the event the discomfort is quite negative." As element on the focus group participants had been shown a 3 minute video clip on amitriptyline medication [24] (which is often prescribed ahead of bedtime for fatigue and discomfort in chronic musculoskeletal circumstances), including how it functions, dosage and its advantages for managing chronic nerve discomfort.