The overall quality of evidence supporting acupuncture for chronic pain is low to moderate, depending on the condition. Systematic reviews and meta-analyses demonstrate that acupuncture provides modest but clinically meaningful improvements in pain and function compared with usual care or no treatment, with smaller but statistically significant benefits compared with sham acupuncture. Sham acupuncture refers to a comparison control used in clinical trials that can include shallow or non-penetrating needles or regular needling on non-acupuncture point areas. Studies involving sham acupuncture typically demonstrate mild therapeutic effects in the sham group, which can contribute to the apparent lesser improvements observed with real acupuncture. However, variability in trial quality, particularly heterogeneity in comparator groups and condition definitions, limits the quality of the evidence base. The American College of Physicians recommends acupuncture as a nonpharmacologic option for the management of chronic lower back pain. Evidence suggests that, in addition to lower back pain, acupuncture can achieve modest pain improvements for neck pain, osteoarthritis, and headache disorders. Acupuncture is also safe and generally well accepted by patients, making it a viable adjunct in multimodal pain care. For insurance-based acupuncture care, the most frequent conditions submitted between 2010 and 2015 were joint-related conditions (e.g., rheumatoid arthritis, osteoarthritis), back pain, connective tissue disorders, anxiety disorders, and headaches or migraines. Future research on implementing acupuncture care for chronic pain may help scale its utilization further.