Voltage-gated sodium (Na V 1) channels play a critical role in modulating the excitability of sensory neurons, and human genetic evidence points to Na V 1.7 as an essential contributor to pain signaling. Human loss-of-function mutations in SCN9A, the gene encoding Na V 1.7, cause channelopathy-associated indifference to pain (CIP), whereas gain-of-function mutations are associated with two inherited painful neuropathies. Although the human genetic data make Na V 1.7 an attractive target for the development of analgesics, pharmacological proof-of-concept in experimental pain models requires Na V 1.7-selective channel blockers. Here, we show that the tarantula venom peptide ProTx-II selectively interacts with Na V 1.7 channels, inhibiting Na V 1.7 with an IC 50 value of 0.3 nM, compared with IC 50 values of 30 to 150 nM for other heterologously expressed Na V 1 subtypes. This subtype selectivity was abolished by a point mutation in DIIS3. It is interesting that application of ProTx-II to desheathed cutaneous nerves completely blocked the C-fiber compound action potential at concentrations that had little effect on A-fiber conduction. ProTx-II application had little effect on action potential propagation of the intact nerve, which may explain why ProTx-II was not efficacious in rodent models of acute and inflammatory pain. Mono-iodo-ProTx-II ( 125 I-ProTx-II) binds with high affinity (K d ϭ 0.3 nM) to recombinant hNa V 1.7 channels. Binding of 125 IProTx-II is insensitive to the presence of other well characterized Na V 1 channel modulators, suggesting that ProTx-II binds to a novel site, which may be more conducive to conferring subtype selectivity than the site occupied by traditional local anesthetics and anticonvulsants. Thus, the 125 I-ProTx-II binding assay, described here, offers a new tool in the search for novel Na V 1.7-selective blockers.Pain relief remains an important, currently unmet, medical need. Voltage-gated sodium channels play a critical role in modulating the excitability of most neurons, including nociceptive sensory neurons signaling pain. Despite the clinical use of systemically administered lidocaine to treat chronic pain since the 1950s (Kugelberg and Lindblom, 1959) and the approval of the weak sodium channel blocker carbamazepine for the treatment of trigeminal neuralgia (Campbell et al., 1966), several oral sodium channel blockers have failed to show efficacy in large clinical trials (Wallace et al., 2002;Vinik et al., 2007). The failure of drugs in the clinic may at least partially be attributed to the narrow therapeutic window of non-subtype-selective sodium channel blockers.Recently, three publications have shown that loss-of-function mutations in the sodium channel subtype Na V 1.7 are the cause for channelopathy-associated insensitivity to pain (CIP) (Cox et al., 2006;Ahmad et al., 2007;Goldberg et al., 2007). Furthermore, genetic linkage analysis has identified gain-of-function mutations in Na V 1.7 as the cause of inherited erythromelalgia (Yang et al., 2004;Han et al., ...