Personally, I don't like and never use this word " pakhe" to anyone. But, I feel that in today's context, if this word is ever used to someone, I don't think it means that person is from outside of Kathmandu. I think it means that that person is backward in terms how he presents himself, that is, in his appearance, behaviour, talking or thinking manner etc etc.  So, friends here who are outside of Kathmandu need not relate or react to this word "Pakhe". Pakhe is someone who is not considered civilised by a conventional society ( I know this word itself is debatable).  So, he/she might not be necessarily from outside of Kathmandu. He/she can by all means be from Kathmandu too. As a matter of fact, I have met many American pakheys here in midwest. So friends, even if you belong to somewhere outside of Kathmandu in Nepal, but you are very much civilized and updated people, don't take this word directed to you and get agitated.