Slain: Back from Hell is an action-packed game that takes you on a journey through a Gothic world filled with gruesome pixel art foes. The game's protagonist, Bathoryn, seeks to defeat six deadly overlords and liberate six cursed realms. However, Bathoryn must first navigate his way through a blighted land filled with fiendish traps and vile monsters. At the heart of each realm lies a mighty foe that must be defeated to continue Bathoryn's quest. Fail, and you will die gruesomely.

The game features three deadly elemental weapons that can be wielded to exploit weaknesses in different enemy types. Players must learn to quickly switch between weapons to achieve victory. Bathoryn must also carefully time his attacks to overcome enemies and booby traps. To succeed, players must generate, conserve, and unleash their mana wisely. The game's heavy metal visuals are accompanied by an even heavier metal soundtrack recorded by Curt Victor Bryant, formerly of Celtic Frost.