Chronic low back pain (CLBP) remains a challenging condition to manage, one that carries a signifi cant socioeconomic burden. In order to better understand the state of existing literature on non-surgical treatments for CLBP, the North American Spine Society sponsored a special focus issue of The Spine Journal. This review of modalities was one of the papers featured in this issue. Many chiropractors utilize electro-modalities in their practices. Most of these devices deliver some type of electrical input to tissue with the goal of reducing infl ammation and swelling, controlling pain, modulating muscle activity, increasing or maintaining strength, and/or enhancing healing. Such modalities are also frequently used by physiotherapists. Unfortunately, there is a dearth of evidence to support their effi cacy, particularly for chronic LBP. The state of the literature for each modality as it pertains to CLBP will be summarized below. Some may be surprised by the lack of research on these commonly used devices for CLBP, a condition commonly treated in most chiropractic offi ces. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) – SIX RCT AND A COCHRANE REVIEW: .A Cochrane Collaboration Review concluded that there are too few studies on which to base recommendations. .Six other RCT identifi ed: number of treatments utilized and specifi c TENS parameters varied. .All six studies included a control group – mostly sham TENS – and utilized low frequency/acupuncture or high frequency. .Two trials showed a signifi cant pain reduction immediately following TENS Treatment (high frequency). .Contradictory fi ndings were noted in the other four studies in post-intervention period assessment. .For low frequency TENS: pooled results indicate a clinically important improvement (without statistical signifi cance) in pain intensity .short-term follow-ups seem to demonstrate more benefi t than long-term follow-ups Interferential Current – no eligible studies found Electrical Muscle Stimulation – no eligible studies found Ultrasound – no eligible studies found Hot/Cold/Ice Packs (Thermotherapy) – no eligible studies found CONCLUSIONS AND PRACTICAL APPLICATION: Although electro-modalities are commonly used to treat CLBP, there is an alarming lack of evidence to support their use. Even the studies on TENS were generally of poor quality, (with 4 of 6 scoring < 2 on the commonly used Jadad Scale). Generally, high and low-frequency TENS seems to have an immediate impact on pain intensity (particularly high frequency), health status, and even acetaminophen use, but all of these fi ndings come from only one study. It should be noted that these results are tenuous at best, and TENS appears to have no effect on long-term pain, or perceived disability. It should also be noted that in both studies, results should be considered immediate, and not even short-term by traditional defi nitions. The results suggest that at best, TENS should be used as an adjunct in short-term treatment plans.