This page covers healer-focused strategies for the Theater of Pain dungeon in Shadowlands. While it's tailored for healers, other roles may also find the information useful. If you have any suggestions or feedback, you can leave a comment below or tweet @PrestonDvorak.

This guide has been updated and maintained based on my own experiences as well as Dungeon Journal and combat log information. I'll continue to update it as-needed.

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 Bosses

Below are guides for the bosses in the Theater of Pain, including their abilities, healer notes, and addon settings.

An Affront of Challengers

• Dessia the Decapitator
  • The tank will be dealing with Mortal Strike, which reduces healing received, and Slam.
  • At 40% health, soothe Enrage to remove the damage absorption effect and prevent attacks against random players.
• Paceran the Virulent
  • Targets random players with Plague Bolt, dealing light damage.
  • Avoid the locations of Noxious Spore pools.
  • At 40% health, dispel Genetic Alteration (disease) to prevent players from creating Noxious Spore pools.
    • If no Disease dispel is available, keep the resulting pools grouped together to maximize usable space.
• Sathel the Accursed
  • Targets random players with Necromantic Bolt, dealing light damage.
  • When affected by Searing Death, stay at least 3-yards away from other players.
  • Purge Spectral Transference to prevent the healing on the affected boss.
  • At 40% health, One with Death grants a damage absorption shield and grants immunity to interrupts while the shield persists.
• On Mythic, Xira the Underhanded
  • Targets random players with Opportunity Strikes, stunning them and dealing heavy damage over time.
    • Xira can be stunned or disoriented to break the effect.

 Healing Notes

• If multiple bosses are bought to 40% health at the same time, be prepared for extra healing required on random players.

 Debuffs to Track

• Major: Mortal Strike, Opportunity Strikes
• Minor: Genetic Alteration (dispel, disease)
• Buffs to Purge: Spectral Transference
• Enrages to Soothe: Enrage

 Addons

• Healer DBM Settings for An Affront of Challengers

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Gorechop

• The tank will be dealing with Hateful Strike.
• Avoid the path of Meat Hooks as the move across the room.
  • Players hit will take light damage over time from Jagged Gash.
• Oozing Leftovers are regularly brought in on Meat Hooks.
  • Oozing Leftovers
    • Lose 5% of their health every 1-second due to Oozing.
    • Avoid the impact location of Leaping Thrash.
    • Upon death, avoid the Coagulating Ooze pool left behind.
• On Mythic, move at least 10-yards away from Gorechop after being pulled in by Tenderizing Smash.

 Healing Notes

• The tank may need an external defensive cooldown to survive Hateful Strike.

 Debuffs to Track

• Minor: Jagged Gash

 Addons

• Healer DBM Settings for Gorechop

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Xav the Unfallen

• The tank will be dealing with Brutal Combo.
• Oppressive Banner reduces all players' movement speed over time in 15% intervals.
• During Might of Maldraxxus, avoid the series of attacks from Xav in the center of the room.
  • Don't stand in the line in front of the boss to avoid Crushing Slam.
  • Don't stand in the hemisphere in front of the boss to avoid Massive Cleave.
• At 100% Energy, Blood and Glory sends two players into the dueling pit.
  • Players have 45-seconds to kill one another, if neither player dies, both are affected by Cowardice, reducing their damage dealt.
  • While in the dueling pit, both players continuously gain stacks of Glorious Combat, increasing their damage taken.
  • The player that dies is affected by Bloodied, reducing their damage dealt.
  • The surviving player gains Glorified, increasing their damage dealt.

 Healing Notes

• The tank may need an external defensive cooldown to survive Brutal Combo.

 Debuffs to Track

• There are no particular debuffs to track.

 Addons

• Healer DBM Settings for Xav

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Kul'tharok

• The tank will be targeted by Spectral Reach (dispel, curse) if not in melee range.
• When affected by Draw Soul, intercept your soul as it moves towards Kul'tharok.
  • While affected, players take heavy damage over time and are pacified by Soulless. 
  • Upon reclaiming your soul, Reclaimed Soul increases damage dealt.
  • On Mythic, failing to intercept the soul causes the affected player to become mind-controlled with Possession.
    • The mind-control effect can be broken by damaging the player a sufficient amount.
• When affected by Phantasmal Parasite (dispel, magic), stay at least 3-yards away from other players.
• Avoid the locations of Grasping Hands.
  • These can be used to root the souls of players affected by Draw Soul, making them easier to reclaim.
• Deals light damage over time to all players for the duration of the encounter with Chill of the Beyond.

 Healing Notes

• Damage can stack up on players depending on who's affected by Draw Soul and Phantasmal Parasite.

 Debuffs to Track

• Major: Phantasmal Parasite (dispel, magic), Draw Soul, Soulless, Spectral Reach (dispel, curse)
• Minor: Grasping Hands

 Addons

• Healer DBM Settings for Kul'tharok

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Mordretha, the Endless Empress

• The tank will be dealing with Reaping Scythe.
• Avoid the Dark Devastation beam.
• Run against the pull of Grasping Rift to avoid being affected by Death Grasp (dispel, curse) within the rift.
• Deals light damage over time and then moderate damage to all players within 6-yards of another player with Manifest Death.
  • On Mythic, each player spawns a Deathwalker.
    • Deathwalker
      • Interrupt Death Bolt to prevent the light damage dealt.
• On Mythic, at 50% health, Echoes of Carnage deals light damage to all players and then light damage over time for the remainder of the encounter.
  • Ghostly Combatants will periodically join the encounter.
    • Ghostly Combatant
      • Stay at least 8-yards away to avoid Echo of Battle.
      • Avoid the path of Ghostly Charge.

 Healing Notes

• Manifest Death can deal a lot of damage if players are stacked up when the effect expires.

 Debuffs to Track

• Major: Death Grasp (dispel, curse)

 Addons

• Healer DBM Settings for Mordretha

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 Trash Mobs

Below are notes for the trash mobs in Theater of Pain. Theater of Pain is a relatively linear dungeon with a choice between which of two wings to clear before the other. The trash below is ordered as if you're completing the bosses in the order they're listed above.

Entrance thru An Affront of Challengers

• Raging Bloodhorn
  • Deals light damage over time to all players with Raging Tantrum.
• Unyielding Contender
  • Soothe Death Wish (enrage) to remove the increased damage dealt effect.

An Affront of Challengers thru Gorechop

• Diseased Horror
  • Applies stacks of Decaying Blight (dispel, disease) to random players, reducing maximum health.
  • Meat Shield grants a damage absorption shield.
• Putrid Butcher
  • Targets random players within 12-yards with Chop, dealing light damage over time.
  • Heal themselves with Devour Flesh.
• Disgusting Refuse
  • Upon death, avoid the Withering Blight (dispel, disease) impact location.
• Rancid Gasbag
  • Don't stand in front or behind when Vile Eruption is cast.
  • Deals moderate damage over time to all players with Disease Cloud.

Gorechop thru Xav

• Shambling Arbalest
  • Target random players Jagged Quarrel, dealing light damage over time.
• Ancient Captain
  • Stay at least 8-yards away to avoid the interrupt from Shield Bash.
  • Reduces damage dealt by all players with Demoralizing Shout.
• This area also includes a selection of enemies from the following choices.
  • Nekthara the Mangler
    • Stay at least 10-yards away to avoid Whirlwind.
    • Don't cast spells as the Interrupting Roar cast finishes to avoid the interrupt effect.
    • Avoid the locations of Whirling Blades.
  • Heavin the Breaker
    • Applies Colossus Smash to the tank, increasing damage taken.
    • Don't stand in front when Ground Smash is cast.
    • When targeted by Ricocheting Blade, stay at least 5-yards away from other players.
    • Don't cast spells as the Interrupting Roar cast finishes to avoid the interrupt effect.
  • Harugia the Bloodthirsty
    • Interrupt or soothe Battle Trance (enrage) to remove the increased attack speed effect.
    • When targeted by Ricocheting Blade, stay at least 5-yards away from other players.
    • Avoid the impact location of Bloodthirsty Charge.
  • Rek the Hardened
    • Applies Unbalancing Blow to the tank, reducing dodge, parry, and black chance.
    • Stay at least 10-yards away to avoid Whirlwind.
    • While Swift Strikes is active, all attacks deal damage to two additional players.
  • Dokigg the Brutalizer
    • Interrupt or soothe Battle Trance (enrage) to remove the increased attack speed effect.
    • Avoid the impact location of Brutal Leap.

Xav the Unfallen thru Kul'tharok

• Avoid the impact locations of Necrotic Volley during the first portion of this section.
• Shackled Soul
  • Interrupt Bind Soul to prevent the light damage over time and decreased movement speed effect.
• Portal Guardian
  • Deals light damage over time to all players with Soulstorm.
  • Dispel Shadow Vulnerability (curse) to remove the increased shadow damage taken effect.
  • Upon death, leaves behind a Strange Orb which must be placed in the Orb Holder of the nearby portal to activate it.
• Bone Magus
  • Interrupt Bone Spear to prevent the damage dealt to a random player.
• Soulforged Bonereaver
  • Avoid the impact locations of Bone Spikes.
  • Stay at least 8-yards away to avoid Bonestorm.
• Maniacal Soulbinder
  • Interrupt Necrotic Bolt Volley to prevent the healing absorption effect applied to all players.
  • Dispel Soul Corruption (magic) to remove the moderate damage over time effect.
• Nefarious Darkspeaker
  • Dispel Curse of Desolation (curse) or stay at least 3-yards away from other players to prevent the damage dealt.
  • Don't stand in front when Death Winds is cast to avoid the knock back effect, which will likely knock players hit off the platform.

Kul'tharok thru Mordretha

• There is no notable trash on the way to Mordretha.

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 Trash Debuffs to Track

• Major: 
  • Curse Dispel: Shadow Vulnerability (dispel, curse), Curse of Desolation (dispel, curse)
  • Disease Dispel: Withering Blight (dispel, disease), Decaying Blight (dispel, disease)
  • Damaging: Colossus Smash, Unbalancing Blow
  • Incapacitating: Vile Eruption
• Minor:
  • Magic Dispel: Soul Corruption (dispel, magic)
  • Damaging: Bind Soul, Jagged Quarrel, Ricocheting Blade, Chop, Bone Spear, Necrotic Bolt Volley
• Enrages to Soothe: Death Wish, Battle Trance
• Buffs to Purge: None

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 Trash Addons

• Useful addons will be added as they're available.

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 Mythic+ Notes

Below are notes that pertain to high mythic+ levels and certain affixes. What constitutes a high mythic+ level will depend on your gear and group, so if you out-gear a particular mythic+ level these notes may not apply. The notes are grouped by affix but are in no particular order.

• Tyrannical
  • No exceptional interactions noted yet!
• Fortified
  • Raging Bloodhorn
    • Raging Tantrum may require minor cooldowns to survive.
  • Heavin the Breaker
    • The tank may need external defensive cooldowns while affected by Ground Smash.
  • Rancid Gasbag
    • Disease Cloud may require minor cooldowns to survive.
  • Portal Guardian
    • Soulstorm may require minor cooldowns to survive.
• Sanguine
  • Battlefield Ritualist
    • Can be difficult to move due to their preference for casting spells. Be ready with knock backs and interrupts.
  • Raging Bloodhorn
    • Will not move while channeling Raging Tantrum.
  • Portal Guardian
    • Will not move while channeling Soulstorm.
  • Maniacal Soulbinder
    • Can be difficult to move due to their preference for casting spells. Be ready with knock backs and interrupts.
• Bolstering
  • Raging Bloodhorn
    • Should probably be killed first, or carefully killed at the same time as other enemies.
• Grievous
  • No exceptional interactions noted yet!
• Raging
  • Raging Bloodhorn
    • Must be soothed quickly if channeling Raging Tantrum.
  • Rancid Gasbag
    • Must be soothed quickly to avoid additional damage from Disease Cloud.
  • Heavin the Breaker
    • Should be soothed quickly to avoid additional damage from Colossus Smash.
  • Rek the Hardened
    • Should be soothed quickly to avoid additional damage from Unbalancing Blow and Swift Strikes.
  • Portal Guardian
    • Must be soothed quickly if channeling Soulstorm.

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 Videos

Mythic 0 Clear, Restoration Druid PoV

Below is a video of me clearing Theater of Pain on Mythic 0 difficulty.

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