INTRODUCTION: Acupuncture, in particular, has received increasing attention in pain management in traditional medicine treatments. This study evaluated the effectiveness of acupuncture in treating nape back myofascial pain syndrome (MPS). METHODS: The literature on randomized controlled trials of acupuncture in the treatment of nape back MPS was retrieved by searching nine databases. Review Manager 5.4 software was used to merge and statistically analyze the extracted data, and Stata 18.0 was used to assess the risk of bias. RESULTS: Finally, 10 randomized controlled trials were included, with a total of 624 samples. The meta-analysis results indicated that acupuncture therapy could lower the NDI score [MD=-6.64, 95% CI (-10.95, -2.33), Z = 3.02, P = 0.003]. Acupuncture demonstrated superiority over the control group in addressing nape back myofascial pain condition, which reflected that the VAS score of the acupuncture treatment group was significantly lower than that of other treatment controls [SMD=-0.71, 95% CI (-1.07, -0.36), Z = 3.94, P < 0.0001]. Furthermore, in contrast to the control group, the improvement of PPT and right flexion CROM and rotation CROM in the acupuncture group was more evident (PPT: [MD = 0.95, 95% CI (0.63, 1.27), P < 0.001]) (right flexion CROM: [MD = 4.86, 95% CI (1.61, 8.12), P = 0.003]), (rotation CROM: [MD = 0.52, 95% CI (0.43,0.61), P < 0.00001]). CONCLUSION: This study demonstrates that acupuncture is more effective in treating nape back MPS than the control group and provides strong evidence for the effectiveness of acupuncture in treating nape back MPS, filling a gap in the treatment of nape back MPS by Traditional Chinese Medicine.