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Upper Back Pain (25 player)
Defeat Icehowl while at least 4 Snobolds remain alive in 25-player mode.
Upper Back Pain (25 player) requires you to defeat Icehowl, the third boss in the Trial of the Crusader raid, while at least 4 Snobolds remain alive throughout the entire encounter.
Enter Trial of the Crusader
Enter the Trial of the Crusader raid on 25-player mode and engage Gormok the Impaler, the first boss. The 4 Snobolds ride on Gormok's back and will drop to the floor when he dies — you do not need one on your back to qualify for the achievement.
Kill Gormok Quickly
Burn Gormok down fast so that all 4 Snobolds drop off his back before any of them can be killed. At modern gear levels this happens naturally, and the Snobolds may even become untargetable, making them trivially easy to preserve.
Avoid AoE Through All Phases
Do not use any AoE abilities during Phase 2 (Acidmaw and Dreadscale) or Phase 3 (Icehowl), as this will kill the Snobolds standing on the floor and invalidate the achievement. Focus all damage on the bosses only.
Defeat Icehowl with Snobolds Alive
Kill Icehowl while all 4 Snobolds are still alive to complete the achievement. If you avoided AoE throughout the fight and did not kill any Snobolds, the achievement will be awarded upon Icehowl's death.
Tips
During Phase 2, using Bloodlust or Heroism on Acidmaw is recommended, as the poison debuff can be difficult to manage if a Snobold is also slowing you.
If playing a class with a pet such as Beast Mastery Hunter, letting your pet tank the bosses while you avoid AoE is an effective solo strategy.