Other player vs player based game modes include deathmatch, team deathmatch, capture the flag and duels. Endless waves of enemy hordes will attack the player or players. In survival mode, up to eight players battle for survival in a limited area of one map. The entire single-player campaign can be played by two people and the level of difficulty adjusts in accordance with the 2 players, either through the number of enemies or the amount of hit points. Painkiller: Hell & Damnation also adds several multiplayer modes to the series. New guns will also be available such as the Soulcatcher, which shoots saw blades in primary firing mode and sucks the souls out of the enemies with its secondary firing. Several classic weapons return, including the Painkiller, the stakethrower, the shotgun, and the electrodriver. Each level presents a new location with various themes and includes castles, monasteries, graveyards, and more.

The game is divided into several chapters, each with several levels.

The player has to get through each level, from start to finish, by slaughtering multitudinous demons.

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