Cooper, A. H.; Chrysostomidou, P.; Jurado Santos, A.; Cui, H.; Adesida, S.; Redondo Canales, M.; Bakina, A.; Barry, A. M.; Baskozos, G.; Bennett, D. L.; Weir, G. A.

Excessive primary afferent activity sustains neuropathic pain, but safe and effective therapeutic inhibition has proved elusive. Realising the promise of gene therapies to meet this challenge requires strategies to identify and selectively target the neuronal populations responsible. Here, we use chemo- and optogenetic approaches to demonstrate that activity in injured afferents drives spontaneous pain but is dispensable for normal sensory function, thereby creating a therapeutic opportunity. Guided by chromatin accessibility profiling, we create an injury-responsive viral vector that confers >95% specificity for injured sensory neurons. Combined with the translationally relevant chemogenetic PSAM4-GlyR, this targeting module effectively silences hyperexcitable human sensory neurons and alleviates spontaneous neuropathic pain in mice. These findings establish precision cell-state targeting of sensory neurons as a promising therapeutic strategy for chronic pain.