This essay examines the cultural pursuit of a painless ideal as a neglected context for US literary realism. Advances in anesthesia in the final decades of the nineteenth century shared with influential religious ideologies including the New Thought an assumption that a comfortable existence insulated from physical suffering represented the height of civilization. Theories connecting the civilizing process to an intensifying sensitivity to suffering were often adduced to justify the revulsion from physical pain increasingly characteristic of the era. Similarly invested in the eradication of physical suffering as a civilized ideal, sentimentalism deploys suffering instrumentally in the hopes of encouraging empathy as well as personal and political agency. Mediating between these anesthetizing and sentimentalist sensibilities, realists including Edith Wharton, Henry James, and William Dean Howells espouse an aesthetic sensibility premised on a sensitive yet restrained engagement with pain. They thereby challenge the prevalent association of superiority with a sensitive revulsion from pain while simultaneously evincing a deep skepticism about whether exposure to physical suffering could inspire social change. This essay first surveys the medical advances, religious ideologies, and consumerist tendencies that contributed to the burgeoning perception of painlessness as a desirable and increasingly feasible goal before examining the implications of sentimentalist intensifications of pain for identificatory and reformist purposes. It then explores realism as an aesthetic approach that distinguishes itself from these two distrusted alternatives by expressly depoliticizing pain while foregrounding its intrinsic sensitizing value. Analysis of writings by Wharton, James, and especially Howells reveals realism's investment in representing physical suffering as a catalyst for a ruminative, sensitive, and reticent responsiveness that the realists associated with refinement.