Burke is back, but still lurking in the shadows, unable to return home. He is prowling the unfamiliar streets of Portland, Oregon, in search of a runaway teen. By all accounts, Rosebud Carlin is a happy, well-adjusted girl. She doesn't fit the profile of the runaway kids Burke knows so well...and once was. But there's something about her father...

Burke knows the street script, but the actors are all strangers. Cut off from his family and his network of criminal contacts, Burke is forced into a dangerous alliance with a renegade group dedicated to providing relief to those in intractable pain by any means necessary. A bargain is struck, and the fuse is lit. Heart-stopping and hard-hitting, Pain Management is the latest bout in Andrew Vachss's thrilling reign as undisputed champ of brass knuckles noir.