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Trojan Horses
Pain Management
by Andrew Vachss

Pain Management by Andrew Vachss, a Burke Novel
Vintage, 2002 (trade paperback, ebook, Kindle)
Brilliance Audio, December 29, 2010 (audiobook)

"Burke's world is harsh and unforgiving, but so is Burke. It's a match made in hell, and a growing contingent of dedicated noir fans wouldn't want it any other way." That's what Booklist said about Pain Management, Vachss' reinvention of the Burke series. Library Journal called it "another winner," and Publishers Weekly said it "keep[s] [the Burke] series alive and vigorously kicking."

And as for accuracy and relevance ... the CSAM News, the quarterly newsletter of the California Society of Addiction Medicine, said, "The snippets about physicians' treatment of pain have verisimilitude and accurately capture some of the current debate between physicians involved in pain management, physicians in addiction medicine, and mainstream society."

Pain Management was inspired by the overwhelmingly intense reaction to Andrew Vachss' short story, "Dope Fiend," which appears in Everybody Pays and Proving It, the first Andrew Vachss audiobook collection. To hear Burt Reynolds perform "Dope Fiend," click here.

Read an excerpt from Pain Management.


Burke has gone "missing-and-presumed" from his native New York City, following a failed assassination attempt. The shadowy man-for-hire is scratching out an existence in the Pacific Northwest, doing what he calls "violence for money," and waiting to see if it is safe to return.

When Gem, the professional border-crosser who calls herself his wife, brings him a job tracking down a runaway teenager, Burke enters a long, dark tunnel of lies—lined with many more games than players.

He takes to the unfamiliar streets, quickly and brutally establishing a presence. The whisper-stream carries him to a fanatical group of criminal samaritans dedicated to supplying adequate drugs for those suffering from chronic pain. Forced into a dangerous alliance, Burke walks the wire between betrayals, risking it all for a girl he has never met. The State-raised outlaw knows better than most that there are many kinds of pain. And many ways to "manage" it.


"I've always been a great fan of Andrew Vachss' work, but I'm an even bigger fan now. Pain Management is wonderful! He's taken the series in sharp new directions that amaze, entertain, and dazzle us with his genius. And, as always, underneath his dazzle is a novel as serious as . . . well, pain management.

"The world Andrew Vachss has created—Burke's world—is inimitably dark, feverish, nightmarish, and righteous. Pain Management is a compulsively page-turning journey into the hellish outer regions of the human psyche. Read it and be changed."


"It is a terrific book. Andrew Vachss returns with Burke, who, in searching for a runaway girl, also exposes our medical professionals' treatment of intractable pain. It is another harrowing adventure for Burke, who goes to ground and finds what's under it. This is a series unlike any other, by a writer who has never lost his commitment to the innocent, to the 'Children of the Secret.'"

Pain Management by Andrew Vachss, a Burke Novel
Knopf, 2001 (hardcover)

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