The song's title is taken from the reported last words of Vincent van Gogh, "La tristessa durera toujours", quoted in a letter from his younger brother Theo to their sister Elisabeth, using her nickname Lies. The letter was translated by Robert Harrison, who states that the phrase means "The sadness will last forever".
The song lyrics are written from the perspective of a war veteran, containing the line "wheeled out once a year, a cenotaph souvenir" and tracking the bathetic progress of the former soldier's war medal: "It sells at market stalls/Parades Milan catwalks".Richey Edwards told Melody Maker newspaper, "It's a beautiful image when the war veterans turn out at the Cenotaph, [...] and everyone pretends to care ... but then they're shuffled off again and forgotten." According to Martin Power in his book Manic Street Preachers, the band "sounded at sixes and sevens" in the rest of the album, "Yet, as with Generation Terrorists, they had again produced one genuine classic in the form of 'La Tristessa Durera (Scream To A Sigh)'."
Edwards wrote the lyrics, and also played rhythm guitar on the track.