Objective A systematic review of randomised controlled trials was conducted to evaluate the efficacy and effectiveness of intramuscular stimulation (IMS). Methods Electronic databases including Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, the Cochrane Library, China National Knowledge Infrastructure, KoreaMED, Korean Studies Information Service System, RISS and DBPIA were searched through June, 2012. The Cochrane criteria were used to assess the risk of bias for the individual studies. Results A total of 416 publications were initially collected and four studies were included in this review. One study evaluated the efficacy of IMS for chronic tension-type headaches; IMS showed a better effect than the sham (headache index: mean difference (MD) −4.90, 95% CI −9.53 to −0.27). Three studies tested the effectiveness of IMS for various conditions. In the first study no significant difference was observed in a comparison of IMS and meloxicam therapy for chronic shoulder pain (pain-visual analogue scale (VAS): MD −0.05, 95% CI −0.25 to 0.16). The second study in patients with myofascial pain syndrome of the upper trapezius muscle found that IMS had a greater effect than simple dry needling measured by the pain-VAS (MD −2.70, 95% CI −3.77 to −1.63). In the third study, patients with lower back pain who received IMS plus the standard treatment had a better status at discharge than those receiving the standard treatment alone (relative risk 1.63, 95% CI 1.18 to 2.24). Conclusions Despite the positive results of these individual studies, the level of evidence supporting the efficacy and effectiveness of IMS for several conditions remains insufficient because of concerns about a lack of precision and a high risk of bias of the included studies. Rigorous large-scale clinical trials of IMS are needed to evaluate the clinical utility of this technique.