Chronic Pelvic Neuralgia Following Finasteride Exposure: A Case Report Suggestive of Nociplastic Dominant Pain

A 29-year-old male developed chronic pelvic pain and erectile dysfunction after using finasteride for androgenic alopecia. Despite various treatments, including pharmacological therapy and interventions like lumbar epidural steroid injection, no significant improvement was observed. Imaging showed perineurial thickening but no compressive pathology, and a low neuropathic screening score suggested a nociplastic-dominant pain mechanism. The case highlights the importance of mechanism-based assessment to avoid unnecessary procedures and emphasizes a shift towards pain education, behavioral strategies, and rehabilitation-focused care for managing such pain.