The three-time All-Star led all scorers with 25 points, including 13 in the final three minutes, and added eight assists.
Paul, who missed 37 games last season due to injury, put New Orleans ahead for good with 2:33 remaining, sending Houston (0-4) to their worst start since 1999.
The Hornets, meanwhile, remained one of the three unbeaten teams in the NBA alongside the Atlanta Hawks and two-time defending NBA champion Los Angeles Lakers.
"We talked about being as desperate as (the Rockets) are before the game," Hornets first-year coach Monty Williams told reporters.
"I asked the guys, 'How would you feel if you were 0-3?' That was my mindset all day. How would I feel if we were 0-3?"
Guards Kevin Martin and Aaron Brooks each scored 18 points for Houston, who led by one point with three and a half minutes to play before New Orleans surged to the finish.
Brooks was ejected in the final minutes after receiving a double technical for arguing a call.
"It's been the same story for four games now," Houston coach Rick Adelman said. "We right in that game with a couple minutes to go, and we're just not finishing them."
China's Yao Ming, who missed last season after surgery on his left foot, had 15 points.
Marco Belinelli added 18 points for the Hornets who trailed by nine in the third before a 14-2 run helped them go ahead by two heading into the fourth.
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