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Three Sixty Pain Spike (10 player)
Defeat Lord Jaraxxus while at least two Mistresses of Pain are alive in 10-player mode.
Three Sixty Pain Spike (10-player) requires defeating Lord Jaraxxus in 10-player mode while at least two Mistresses of Pain are alive simultaneously.
Enter Trial of the Crusader
Enter the Trial of the Crusader raid and engage Lord Jaraxxus. Burn him down to between 3–6% health, then stop all damage on him.
Let the Nether Portal stand
When a Nether Portal opens, do not destroy it — allow it to remain open long enough for two Mistresses of Pain to spawn, which occurs roughly every 5–10 seconds.
Kill Lord Jaraxxus
Once two Mistresses of Pain are alive at the same time, immediately kill Lord Jaraxxus without attacking the Mistresses. Both Mistresses and the Nether Portal despawn upon his death, and the achievement is awarded.
Tips
This is easiest to execute when your group has enough healing to survive both Mistresses of Pain simultaneously while holding damage on Lord Jaraxxus at low health.
The add spawn order has been observed as: Mistress, Infernals, Mistress, Infernals — so letting the first Mistress live and waiting for the second is a reliable method to trigger the achievement condition.