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What does a guy mean when he says, "I love you so much it literally hurts, but I know deep down that good things don't last forever”?

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It means he’s being super-dramatic and you get the unenviable task of trying to take him with just the right amount of seriousness.

He doesn’t think he deserves to be with you. This normally isn’t a problem, but guys who express these sorts of feelings in such a melodramatic way have ways of turning them into self-fulfilling prophecies.

And there’s not a whole lot you can do about it. Guys get into this mental state a lot where they have feelings of inadequacy that they think that you could solve for them, but really they are rooted in his psyche and since you’re not a psychologist, you can’t exactly go rooting around in there looking for things to fix. His road to absolution from his self-torture is going to be long and hard.

I’m not saying you should dump him, but you should consider taking him at his word.