Our goal was to perform a pilot, open‐label, prospective study to access the effectiveness and tolerability of a topical lidocaine patch (Lidoderm) for the treatment of peripheral neuropathic pain conditions other than postherpetic neuralgia. Sixteen patients with refractory peripheral neruopathic pain conditions who had reported intolerable side effects or inadequate pain relief with antidepressant, anticonvulsant, antiarrhythmic, and opioid medications participated in this study. Diagnoses included postthoracotomy pain, stump neuroma pain, intercostal neuralgia, diabetic polyneuropathy, meralgia paresthetica, complex regional pain syndrome, radiculopathy, and postmastectomy pain. A 6‐item Pain Relief Scale was used. Moderate or better pain relief was reported by 13 of the 16 participants (81%). One patient stopped treatment after 4 days due to lack of relief. The remaining 15 patients had a mean duration of patch use of 6.2 weeks with continued relief. Only 1 patient reported a side effect, a mild skin irritation. Conclude the Lidoderm patch provides clinically meaningful pain relief in most of these refractory neuropathic pain patients without side effects. Controlled trials need to be performed to confirm these preliminary findings.Comment by Tat‐Leang Lee, M.D. This is an interesting study that highlighted a simple, efficacious method for the treatment of resistant neuropathic pain. As this was a pilot study using an open‐label method, and treating a heterogenous group of neuropathic pain conditions, caution should be adopted in the interpretation of the results. What remains unanswered is the reason for the success of the lidocaine patch, particularly when previous studies have documented the failure of EMLA in the treatment of neuropathic pain. Indeed, several patients who participated in this study had used EMLA unsuccessfully before, although no details on its administration was reported. Both the lidocaine patch and EMLA contain 5% lidocaine, which presumably would result in greater penetration by the EMLA cream. Therefore, a placebo‐controlled randomized trial is needed to confirm the findings of this pilot study. Nevertheless, this is a promising treatment that is convenient, lacks systemic effect, easily added‐on to existing treatment, and with only minor side effects, that is worth considering for our patients.