Pain Elementals do not attack their targets directly; they spit out Lost Souls to attack the target. The longer it takes to destroy the demon, the more Lost Souls will be summoned. However, if there are more than twenty Lost Souls in the level, no more will be spawned until some are killed, potentially making the Pain Elemental harmless. An infamous scene in the Doom custom level pack Hell Revealed had several Pain Elementals rendered harmless by the limit (20 Lost souls were hidden in a room outside the normal level. When the player picked up a key card, the hidden Lost Souls would be crushed and the Pain Elementals would attack. When killed, the Pain Elemental explodes, spawning three Lost Souls, unless restricted by the twenty Lost Soul limit. As with the Cacodemon, the Pain Elemental has 400 HP.