BACKGROUND: Chronic musculoskeletal pain (CMP) affects around 1.7 billion people globally, causing significant physical, psychological, and economic burdens. Current treatments often involve medications with risks, creating an urgent need for accessible alternatives. Interventionist-administered Auricular Point Acupressure (APA) has shown effectiveness in reducing pain. To explore whether this low-risk, non-invasive, non-pharmacologic, and non-opioid pain relief method can be expanded digitally, this study developed a self-managed APA program using mobile health technology and coaching videos, allowing individuals to self-administer APA and evaluate its impact and sustainability. METHODS: A 3-group pilot randomized controlled trial was conducted among 37 participants with CMP. The participants were randomly assigned to in-person APA (n=14) with face-to-face APA instruction, self-guided APA (n=12) with remote APA coaching, or control (n=11). All received conventional healthcare, with the APA groups also receiving adjuvant APA intervention for a 4-weeks supplemented with mobile app coaching videos, followed by monthly monitoring for three months. Data on pain intensity, physical disability, physical function, anxiety, depression, fatigue, sleep disturbance, fear avoidance of work, and satisfaction were collected at baseline, immediately following the 4-week APA intervention, and during the 2-month and 3-month follow-ups post-intervention. RESULTS: Both the in-person and self-guided APA groups experienced a 47% reduction in pain intensity. Over 50% of participants achieved at least a 30% reduction in pain, and more than 17% had a 30% reduction in physical disability. Improvements included an 18% boost in physical function, decreased fatigue, improved sleep disturbance, and less depression (with increases noted in the control group), a 50% reduction in fear-avoidance of work, and only 3.8% reported not being satisfied with the APA at the 3-month follow-up. No adverse effects related to APA were reported. CONCLUSION: APA improved physical and mental health in participants with CMP, enhanced readiness to return to work, and demonstrated sustainability for at least three months. Coaching videos delivered via a mobile app proved to be a feasible approach for teaching APA, increasing the accessibility of the intervention. This study highlights the impact of APA and recommends further research into its mechanisms and long-term benefits to support integration into standard practice.