OBJECTIVE: Efficacious modalities are limited in chronic low back pain (cLBP). We determined the efficacy of auricular point acupressure (APA) in older adults with cLBP. METHODS: Participants, ≥ 60 years with cLBP, were randomized (1:1:1) to APA with ear points targeted to cLBP (T-APA, n = 92), points non-targeted to cLBP (NT-APA, n = 91), or waitlist education control (n = 89), and followed up to 6 months (6M). Participants in the APA groups received 4 weekly APA sessions; the education control group received 4 weekly educational sessions. Primary outcomes were pain and function. RESULTS: There were 272 participants (174 women [64%]; mean [SD] age 70.0 [6.95] years; 62% non-White). Compared to control, the T-APA group had significant improvement on pain from baseline to post-intervention and one-month (1M) follow-up by 1.73 and 1.26 points (p ≤ 0.001) respectively. The NT-APA group achieved similar improvements in pain. The improvement in function by T-APA and NT-APA was significant at post-intervention by 1.89 and 2.68 points (p = 0.04 and 0.004) respectively, minimal at 1M follow-up, but significant at 6M in both APA groups. There were no statistically significant differences in treatment responses between the APA groups. Both APA groups had higher responder rates in pain and function at post-intervention and 1M follow-up compared to the control group (odds ratio ranged from 2.11 to 6.32). The APA effects were sustained at 6M follow-up. CONCLUSIONS: APA treatments significantly improved pain and function compared to control; effects were sustained at 6M. APA should be recommended as a nonpharmacologic therapy for older adults with cLBP.