Hindlimb pain is a common clinical presentation in dogs and may be managed with treatments ranging from pharmaceuticals to integrative therapies such as acupuncture. This pilot study evaluated whether vitamin B12 aqua-acupuncture at BL-40, an important acupoint for hindlimb pain, improved clinical signs in adult dogs. Client-owned dogs with hindlimb pain and a Canine Brief Pain Inventory (CBPI) score >25 on a 0–100 scale were enrolled. Exclusion criteria included cranial cruciate ligament rupture, intervertebral disc disease-related hindlimb pain, lameness associated with neurological deficits, abnormal muscle tone/spasticity, or acupuncture within the previous 6 months. Eligible dogs were randomly allocated to a Test Group (n=18), which received aquapuncture in addition to current treatment, or a Control Group (n=17), which continued current treatment alone. Outcome assessments performed at Weeks 0, 2, 4, 8, and 12 included owner-completed CBPI scores, force plate analysis, range of motion (ROM), lameness scoring, and thigh circumference, with assessors blinded to group assignment. The CBPI pain severity scores improved significantly more in the Test Group, with significant between-group differences at Weeks 2, 4, and 8, and a significant overall group effect across improvement assessments (p=0.046). Only the Test Group showed significant improvement in hip ROM. Lameness improved in 27.8% of test dogs versus 5.9% of controls, and thigh circumference increased significantly more in the Test Group when compared to controls. Neither group showed significant improvement in force plate outcomes. These findings suggest that vitamin B12 aqua-acupuncture at BL-40 may provide clinical benefit for dogs with hindlimb pain.