Objectives: Acupuncture has been used to treat most pain conditions for a long time, and a lot of acupuncture studies have been conducted on them. However, its efficacy compared to sham acupuncture is still controversial. The objective of this study was to investigate whether the outcome of verum acupuncture differs according to the stimulation points of sham acupuncture for representative pain conditions in previous acupuncture clinical trials. Methods: Sham acupuncture-controlled acupuncture trials for pain conditions including chronic nonspecific low back pain, knee osteoarthritis, and cancer pain were screened, respectively. Sham acupuncture was classified into two types depending on whether the stimulation was applied at the same locations as the verum acupuncture group (Sham AT(verum)) or not (Sham AT(sham)). A network meta-analysis was performed based on a frequentist approach and a consistency model to compare effect estimates on pain and function. Results: There was no difference between Sham AT(verum) and the verum acupuncture group. However, verum acupuncture significantly improved pain and function after treatment compared to Sham AT(sham) in three pain conditions, respectively. Especially, Sham AT(verum) showed significant improvements compared with Sham AT(sham) in some pain conditions. Conclusion: In previous acupuncture trials for pain conditions, the outcome of sham and verum acupunctures differed depending on the stimulation points of sham acupuncture. Sham acupuncture stimulation at the same points as verum acupuncture cannot be considered a true placebo, which leads to an underestimation of the efficacy of verum acupuncture.