The purpose of this systematic review is to review the effectiveness of auricular point acupressure with seeds(APA-S) on pain management, and its method related to acupressure intervention. Nine electronic databases were searched from the establishment of the database until December 31, 2017. All randomized controlled trials (RCTs) were included if they clearly defined APA-S intervention and evaluated pain outcomes. 1511 records were identified, but only 45 studies were identified for analysis. Among the 45 studies, 43 (95.6%) were positive studies which showed that APA-S could effectively relief pain, and/or reduced the analgesics consumption or the use of Patient Controlled Analgesia (PCA) of the experimental groups (based on the final data) while compared with the control groups (P<0.05).37 (86.0%) had a Jadad score of 3, while 4 (9.3%) and 2 (4.7%) had 5 and 4 points respectively. 25 studies (58.1%) focused on acute pain, 18 (41.9%) focused on chronic pain and 16 of them were chronic non-malignant pain studies, 2 of them focused on chronic malignant pain.Besides pain intensity, 7 positive studies considered the consumption of analgesics(n=3) or PCA (n=4) as the measurements of outcome, and all of them found a positive outcome. The remaining 2 studies were negative studies, accounting for 4.4%.Their Jadad score were 3 and 5 respectively.Both of the negative studies focused on acute pain. As far as the method related to APA-S intervention was concerned, among the 43 positive studies, Shenmen(n=43), subcortical(n=33) and sympathy(n=27) were the most commonly adopted acupoints. Vaccaria seeds(n=37) were the most commonly chosen stimulators. Period of AAT-S intervention was different in different category of pain: less than or equal to 3 days(n=14) and 28 days(n=6) was the most commonly period for treating acute and chronic pain respectively.The review begins to establish a credible evidence base for the use of APA-S in pain relief.