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Clinically, IEM is characterised by paroxysmal attacks of severe pain, usually in the distal extremities, triggered by warmth or exercise. Pain is not adequately treated by existing pharmacological agents. Individuals with IEM classically cool their limbs for relief, in some cases resulting in tissue injury. We describe a patient from a family with IEM due to the L858F mutation of Na<jats:sub>v<\/jats:sub>1.7 who presented with refractory hypothermia due to overcooling. This presentation of refractory hypothermia necessitating warming strategies, complicated by severe warmth-induced pain, posed a substantial therapeutic challenge. We report our experience in overcoming hypothermia lasting 3\u2009weeks in a child with IEM, discuss possible pathophysiological mechanisms underlying this unusual complication and suggest potential therapeutic interventions.<\/jats:p>","DOI":"10.1136\/bcr-2017-219486","type":"journal-article","created":{"date-parts":[[2017,7,27]],"date-time":"2017-07-27T05:56:04Z","timestamp":1501134964000},"page":"bcr-2017-219486","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Between fire and ice: refractory hypothermia and warmth-induced pain in inherited erythromelalgia"],"prefix":"10.1136","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4488-2028","authenticated-orcid":false,"given":"See Wan","family":"Tham","sequence":"first","affiliation":[{"name":"Seattle Children's Research Institute, Seattle, Washington, USA"},{"name":"Department of Anesthesia and Pain Medicine, University of Washington School of 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