Objective. To determine whether Tai Chi improves pain, disability, physical performance, and/or health-related quality of life (HRQOL) in people with chronic musculoskeletal pain. Methods. Eight databases were searched for randomized controlled trials (RCTs). Two independent reviewers rated trial quality and extracted trial data. Effect sizes and 95% confidence intervals were calculated for individual trials, and pooled effect sizes were calculated using a random-effects model. Results. Seven RCTs were selected for inclusion in the review. Of these, 6 studied people with chronic arthritis and 1 studied people with chronic tension headaches. The trials were typically small and of low methodologic quality. The pooled effect size for arthritic populations on a 0-100 scale was 10.1 (range 6.3-13.9) points for pain reduction, and was 9.6 (range 5.2-14.0) points for disability reduction. Additionally, physical performance and HRQOL outcomes favored the Tai Chi intervention, but of these outcomes, only the level of tension and satisfaction with general health were statistically significant. Conclusion. The available data on the effect of Tai Chi are sparse and derived principally from low-quality studies. These data suggest that Tai Chi has a small positive effect on pain and disability in people with arthritis. The extent to which it benefits other forms of musculoskeletal pain is unclear.