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I can understand this intellectually/rationally, but I can't imagine actually making such a decision.

I could see making the decision and then chickening out as soon as it was time to get to business.

Me too.

Imagine being in pain, all day, every day.

Can you imagine such a decision now?

Without access to painkillers, sure, yes.

Painkillers don’t work for many types of pain

And they often come with a host of awful side effects and/or are addictive in nature, and often requiring a slowly increasing dose to be effective.