An unusual case is reported with severe erythromelalgia secondary to a sensorimotor polyneuropathy of immunological aetiology. The dominating symptoms were ongoing burning dysesthesia and pain in the legs, sustained thermal hyperalgesia and allodynia to pressure which produced intolerable pain on standing and walking. The primary pain-producing pathophysiology was apparently peripheral neurogenic inflammation with sensitization and excitation of nociceptors. The variable and progressive course prompted reassessments and successively amended multitargeted analgesic regimens. The most intensive bout of widespread pain and allodynia indicating secondary central sensitization was only controlled by adenosine treatment.