A painful state is not caused only by a sufferance brought to us from external circumstances.
For instance, a painful music can be created by surrounding and capturing what is external to music as its contrary, namely, the silence. The rare strings of notes which leave enough space for long pauses can create painful feelings.
But an active causation of painful states is not identical with an intentional creation of painful circumstances. In music, it is the simple manifestation of musical creativity. In life, it is the manifestation of your self (surely, we can see that the musical creativity follows such manifestation of the self).
The manifestation of the self means its consciousness of belonging to the world. The painful manifestation tells about the plain fact that our inclusion into the world shows that our existence is not so important when it is compared with the greatness of the world.
However, the lack of such manifestation might tell about our total lack of importance into the world, since we do not dare to confront it. Moreover, since the external sufferance comes in everyone’s life, the lack of active sufferance leaves us unprepared for enduring them.