Objective To investigate the value of real-time tissue elastography (RTE)-guided acupuncture myofascial trigger points (MTrPs) in the treatment of myofascial pain syndrome (MPS). Methods A total of 60 patients with MPS who were admitted to our hospital from August 2017 to August 2018 were randomly divided into RTE group and traditional acupuncture group. The patients were followed up for 1 years. The elastic score of MTrPs and pain scores before and after treatment was compared between the two groups，and study the correlation between the elastic score and pain scores. The treatment outcome and long-term prognosis of the two groups were compared. Results After treatment, the elasticity scores , visual analogue scale (VAS) and pain assessment index (PRI) of RTE group is significantly lower than the traditional acupuncture group（P<0.05）, the elasticity score was positively correlated with VAS, PRI and current pain intensity (PPI) (both r>0 and P<0.05), and the elasticity score was the strongest correlation with VAS (r=0.673, P=0.000). The MTrPs elasticity score and the VAS change trend in different courses are similar, both show a downward trend (P<0.05). The effective rate of RTE group was 86.7%,the cumulative no-recurrence rate was 93.33%, the effective rate of traditional acupuncture group was 60%, and the cumulative no-recurrence rate was 57.14%. The significant rate and cumulative no-recurrence rate of RTE group were significantly higher than that of traditional acupuncture group (P<0.05).Conclusion The therapeutic effect and prognosis of acupuncture MTrPs guided by RTE are significantly better than traditional hand palpation acupuncture.