The song reached number-one on Billboard Top Latin Songs chart, and became the longest running chart topper of its history, spending 20 weeks at the top; this record was broken five years later by Colombian singer Shakira with "La Tortura" which spent 25 weeks at number-one.

"A Puro Dolor" also reached the Billboard 100; this led to the recording of an English-language version of the track "Purest of Pain", which was also charted in the United States.

The record was covered by Mexican group Dinora y la Juventud and Brazilian boy band KLB both of which received radio airplay.

The success of the singles "Nada" and "No Hay Razón", distributed in Puerto Rico by the independent label RJO, captured the attention of the Sony Music CEO Oscar Llord, who made an agreement with RJO to re-release the album and start the recording sessions of the next album.

[2] Alfanno, well known for his work with salsa recording singers Marc Anthony, Víctor Manuelle, Jerry Rivera and Gilberto Santa Rosa was in charge of the album production.

[3] Alfanno declared that he wrote the song in ten minutes, and that after the success of the track, he analyzed the composition, since he did not understand how "A Puro Dolor" became that popular.

It became very successful with the ballad and tropical and salsa versions setting an airplay record for a Latin single with 23.4 million impressions in those countries.

"[5] In his album review for AllMusic, Evan C. Gutierrez declared that "A Puro Dolor" set "an impossibly high standard for the rest of the playlist.

[9] Alfanno also received a Latin Grammy Award nomination for the Best Tropical Song, which it lost to "El Niágara en Bicicleta" by Juan Luis Guerra.

[14] To promote the single, Son by Four opened a Ricky Martin live performance in the Madison Square Garden in New York City.

[2] They also did a concert with the R&B trio Destiny's Child, and were presented in the 1st Latin Grammy Awards along with the boy band NSYNC, performing the medley "A Puro Dolor"/"Purest of Pain" with "This I Promise You"/"Yo Te Voy a Amar".

In 2000, due to the success of the track in the American market, they were asked to perform on The Tonight Show hosted by Jay Leno.

[51] The success of their cover led to the group receiving a Lo Nuestro Award for New Regional Mexican Artist of the Year.

Piska, a Brazilian producer and composer, wrote the lyrics for a cover version of the song, which was recorded by the boy band KLB, and released in their eponymous debut album under the title "A Dor Desse Amor".

[62] In 2009, Son by Four recorded a new version of the track for their studio album Abba Nuestro which did not have López's involvement as he left the band in 2003.

[65] He also recorded it as a duet with fellow Puerto Rican singer Ana Isabelle on her studio album Mi Sueño (2010).