OBJECTIVE: This study aims to evaluate the efficacy and safety of traditional acupuncture for pain relief based on rigorously designed RCTs with double-blind. The findings seek to provide valuable insights for clinical practice and inform future research. METHODS: A literature search was conducted in PubMed, Web of Science, Cochrane Library, and Embase databases for randomized controlled trials on traditional acupuncture for pain management using a double-blind design, published from database inception to November 22, 2023. The Risk of Bias 2 (RoB2) tool was used to assess potential biases in the included studies, followed by a comprehensive analysis to evaluate efficacy and safety. RESULTS: The findings show a significant positive effect on pain improvement, evidenced by changes in visual analog scale scores (mean difference 0.97 [95% confidence interval (CI) 0.66-1.27]). Safety analysis showed no significant differences in adverse reactions between the acupuncture and control groups (relative risk 1.40 [95% CI 0.52-3.74]), with no serious adverse effects reported. CONCLUSION: Traditional acupuncture is effective and safe in pain management. This suggests that acupuncture can be a valuable approach in clinical practice. Future studies should explore optimal treatment durations and frequency, using larger sample sizes for more comprehensive insights.