A major factor limiting use of NSAIDs is concern for the development of gastrointestinal complications such as bleeding. COX-2 selective inhibitors were developed to decrease the risk of gastrointestinal tract injury and to avoid the anti-platelet effect of traditional NSAIDs. The recent MEDAL study has confirmed this finding by randomizing more than 30,000 patients to either etoricoxib or to the traditional NSAID diclofenate. Furthermore, the MEDAL investigators demonstrated similar cardiovascular outcome measures in both patient groups showing that the use of this has a similar cardiovascular safety profile as the traditional used NSAIDS. Using a safe analgesic with a low rate of adverse events in FMS patients, a population with enhanced somatoform ideation, is of great importance and may also insure the adherence to the other components of therapy.