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September is National Pain Awareness Month, but Alice Klena has never needed a reminder.

“I have always hurt,” she says. “My body has always hurt as far back as I can remember.”

When she was a child, her legs hurt so badly that she cried as her father rubbed them with alcohol in a vain attempt to ease the pain.

Now 71, she says she learned when she was 29 that her pain stemmed from spinal osteoarthritis. She blames it on having had rheumatic fever when she was 2.

As an adult, she sought secretarial and statistical work, jobs in which she could sit a lot. But she couldn’t work for long stretches and eventually gave up.

She raised a daughter and has two grown grandchildren.

“I could never do the grandmother thing with the children,” she says. “I couldn’t baby-sit them alone. They would run and jump up on a chair so I could hug them and kiss them.”

Tens of millions of Americans suffer from chronic pain. The exact number is hard to pin down because the definition of chronic pain varies, says Dr. Andy Kirsteins of Moses Cone Health System’s Center for Pain and Rehabilitative Medicine, where Klena gets treatment. Kirsteins is one of Klena’s doctors.

One definition is pain that lasts beyond six months. Another puts the span at three months. It also can be defined as pain lasting beyond the normal healing time from a disorder or injury.

Chronic pain costs the nation up to $100 billion annually in direct medical costs, lost income and lost productivity. A bill pending in the U.S. Senate would boost research, education and training in pain management to find and apply the most effective treatments.

Chronic pain has many causes. Some of the most common are musculoskeletal disorders and arthritis, nerve problems, persistent headaches and pain from cancer and its treatments. Some organs, such as the pancreas or bladder, can cause chronic pain, Kirsteins says.

Chronic pain can contribute to other health problems. It is associated with anxiety and depression, Kirsteins says.

How to treat pain depends to some extent on where it is, Kirsteins says: “Pain is like an onion. It has many layers.”

It can be at skin level, such as a hypersensitive scar; in the muscles, bones or connective tissue; or in a nerve or organ.

Each level may require different treatment, including surgery, drugs, acupuncture, physical therapy and electrical stimulation.

People may require more than one kind of treatment to manage their pain, Kirsteins says.

Treatment isn’t an exact science, partly because chronic pain has received relatively little study.

For example, pain-management specialists have been divided over whether opioids, potent but potentially addictive painkillers, are underprescribed. If so, many people might be suffering unnecessarily because of fears that they might become addicted. But an increase in their use also has led to more overdoses, Kirsteins says, and patients must be screened carefully.

In Klena’s case, treatment has included multiple operations, medication and battery packs implanted in her back and wired to vertebrae to provide electric stimulation.

But for her, and for many others, pain can only be managed — never ended.

Klena says her pain level hits 3 or 4 on a 1-to-10 scale most days. But some days, “I can’t stand; I can’t lay down; I can’t sit,” she says. “I don’t know where to put my body. Every part of my body aches everywhere.”

When the pain gets bad, she takes painkillers — up to four per day — or she applies pain-killing patches to her skin. She receives an epidural, a local anesthetic injected in or near the spine, every six months or so when the pain level gets up to 10.

“I kiss the ground they walk on,” she says of Cone’s pain center.

But she says a good attitude is as essential as medicine to coping with chronic pain, and at that, Klena has had decades of practice.

“It’s going to hurt, and it’s going to get worse,” she says. “But what do you want me to do? ... I laugh, I smile, that makes you feel good, that makes me feel good, so what the hell? Crying is not going to make it feel better.”

Contact Lex Alexander at 373-7088 or lex.alexander@news-record.com