BACKGROUND: Myofascial Pain Syndrome (MPS) is a prevalent musculoskeletal condition. Acupuncture therapy demonstrates significant advantages due to its unique mechanism of action. However, there are notable discrepancies in the evidence levels among various acupuncture therapies, and direct comparative data between different treatments remain scarce. METHODS: Randomized controlled trials (RCTs) investigating acupuncture therapy for MPS in Neck or shoulder were systematically retrieved from CNKI, Wanfang, VIP, CBM, PubMed, EMbase, Cochrane Library, and Web of Science up to April 30, 2025. Network Meta-analysis was conducted using Stata 16.0. RESULTS: This study included 29 RCTs, involving a total of 2424 patients. Thirteen types of interventions were evaluated in the experimental groups: Fu's subcutaneous needling, Internal heat acupuncture, Electroacupuncture, Round-point needle, Needle knife, Moxibustion, Sunken cord, Acupoint injection, Conventional acupuncture plus Moxibustion, Conventional acupuncture plus Bloodletting, Conventional acupuncture plus Traditional Chinese Medicine (TCM), Conventional acupuncture plus Tuina, and Conventional acupuncture plus Exercise. Regarding the Visual Analog Scale (VAS) scores: The top three therapies based on the Surface Under the Cumulative Ranking Curve (SUCRA) values were Moxibustion (0.84), Internal heat acupuncture (0.84), and Conventional acupuncture plus Moxibustion (0.79). In terms of efficacy, based on the SUCRA rankings for both outcome indicators, Internal heat acupuncture was identified as having the best overall effect. CONCLUSION: Based on the findings of this study, multiple acupuncture methods exhibit significant advantages over conventional acupuncture. Comprehensive analysis indicates that Internal heat acupuncture has the most favorable therapeutic effect.

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