[7] The music video for Nine Inch Nails' original version of "Hurt" is a live performance that was recorded before the show in Omaha, Nebraska, on February 13, 1995, and can be found on Closure and the DualDisc re-release of The Downward Spiral.

In addition to using an uncensored audio track, the Closure edit shows alternate views of the audience and performance at several points during the video.

To film the video, a scrim was dropped in front of the band on stage, projected onto which were various images to add visual symbolism to fit the song's subject matter, such as war atrocities, a nuclear bomb test, survivors of the Battle of Stalingrad, a snake staring at the camera, and a time-lapse film of a fox decomposing in reverse.

Compared to the live renditions performed on future tours, this version most resembles the studio recording with its use of the song's original samples.

Since the 2005–06 Live: With Teeth Tour, Nine Inch Nails has been playing "Hurt" in a more toned-down style, featuring only Reznor on vocals until the final chorus, when the rest of the band joins in.

That song in particular was straight from my soul, and it felt very strange hearing the highly identifiable voice of Johnny Cash singing it.

It's morning; I'm in the studio in New Orleans working on Zack De La Rocha's record with him; I pop the video in, and... wow.

I wrote some words and music in my bedroom as a way of staying sane, about a bleak and desperate place I was in, totally isolated and alone.

[24] The music video was directed by former Nine Inch Nails collaborator Mark Romanek,[25] who sought to capture the essence of Cash, both in his youth and in his older years.

Much of the video is in a style deliberately reminiscent of vanitas paintings, thus emphasizing the lyrics' mood of the futility and passing nature of human achievements.

[2] Romanek had this to say about his decision to focus on the House of Cash museum in Nashville: It had been closed for a long time; the place was in such a state of dereliction.

[29] His wife, June Carter Cash, who is shown gazing at her husband in two sequences of the video, had died on May 15 of the same year.

[63] In 2019 Mumford & Sons performed a cover version as a ballad in their show at Quicken Loans Arena in Cleveland, Ohio, Trent Reznor's origin city.