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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 by any means necessary to those in intractable pain. 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.