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Bounty Rune
Iron BranchIron Branch
Magic Stick
Tango
Bottle
Power Treads
Magic Wand
Aghanim's Scepter
Octarine Core
Bloodstone
Eye of Skadi
Boots of Travel
Shiva's Guard
Orchid Malevolence
Scythe of Vyse
Dagon 1
Enchanted Mango
Necronomicon
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1 | 12 | 13 | 14 |  |
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2 | 4 | 8 | 10 |  |
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3 | 5 | 7 | 9 |  |
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6 | 11 | 16 |  |
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15 | 17 | 18 |
Queen of Pain is a middle lane ganker/teamfighter with a ton of potential to push out lanes and destroy teamfights. This build focuses on dishing out as much damage as possible while staying safe and healthy.
Skills
Shadow Strike is a lovely slow which can be nice to put points into early due to the stable mana cost, but it is delayed until later in order to maximize your damage via Scream of Pain and survivability from Blink. Therefore Scream of Pain is maxed first, with Blink soon to follow, and Shadow Strike is delayed.
Items
The starting items are fairly basic; Iron Branches to give you a stat boost, a magic wand for the burst heal, and some Tangoes to keep you alive. Get Bottle as soon as you can; this will be your main way to survive and stay full on mana. With Blink you can secure runes very easily. After Bottle start working on your Power Treads. NOW finish the Magic Stick and Iron Branches into a Magic Wand, as you are going to want the space for items working into your Aghanim's Scepter.
Once you have Power Treads and a Bottle, it's time to start building your most important item: Aghanim's Scepter. This thing is a beast for Queen of Pain. It increases the damage and lowers the cooldown to 40 seconds. 40 SECONDS. Build it in whatever order seems to make sense; if you need more mana, go 
Staff of Wizardry into 
Point Booster into everything else; if you need more survivability, prioritize the 
Ogre Club.
Now that you have your Aghanim's Scepter, it's time to build the next best thing: Octarine Core. This item reduces the cooldown on Sonic Wave to 30 seconds, enough to use it EVERY CREEP WAVE.. Naturally you want this. Additionally, it gives you a 3 second cooldown on Shadow Strike, a 4 second cooldown on Blink, and a 5.25 second cooldown on Scream of Pain. In addition to all these things, your giant=damage ultimates will now heal you for all the health you could ever want. Furthermore (yea, this item is pretty sweet), the 
Soul Booster in it gives you some much-needed tankiness and a larger mana pool.
OK. You've done it. You have reached the Point of Maximum Imba. Unfortunately, there's a problem. You're running out of mana, and fast. You don't have enough to use your ultimate every two minutes, let alone 30 seconds. Luckily for you, there's a solution: Bloodstone. This thing really speaks for itself; it gives you mana regen and yet more tankiness and mana pool size. Moreover, if you've reached this point, you probably are in the lead or have just turned the game around; with your low-cooldown Blink and massive teamfight destruction, you will start accumulating charges like crazy. To compliment it nicely you also want to pick up an Eye of Skadi, as the slow goes very well with your Blink and Shadow Strike to make sure enemies don't escape your wrath and it gives you more tankiness and mana pool (see a theme here?).
The game has now stretched on for over an hour. You need to piss, badly. You want to win, but the enemies aren't letting you. And you still have one empty slot, hopefully filled by a 
Town Portal Scroll. But it's time to put a real item in there. From here, you should have all the mana you need, but Shiva's Guard ensures that you do, in addition to giving you sweet amounts of armor to survive any fed 
Phantom Assassins you might encounter. Now you have no Town Portal Scroll. Oh no! Don't worry, your Power Treads are obsolete. Buy Boots of Travel II and enjoy porting anywhere on a 32 second cooldown.
Gameplay here is pretty simple. Before you get your Aghanim's Scepter and Octarine Core, play standard Queen of Pain. Gank by initiating with Blink, following up with Shadow Strike directly into Scream of Pain, then hit them a bit and finish them off with a big, juicy Sonic Wave. If your ganks aren't going well, don't worry; this build focuses more on late-game domination than early to mid-game ganking, and you shouldn't give up.
Once you have the Aghanim's Scepter and Octarine Core, gameplay becomes pretty simple. If you see a creep wave, ult it then Blink in and kill all the creeps with Scream of Pain. If your teammates flame you for wasting ult, ping out that it is only on cooldown for 30 seconds. Alternatively, ping out your Aghanim's Scepter and Octarine Core. This should shut them up.
In teamfights, do Queen of Pain things. Shadow Strike as many people as you can; the slow helps you control the fight, and the 3 second cooldown coupled with the 15 second duration means you can slow the ENTIRE enemy team forever (in theory). If a bunch of enemies group up, punish them; ult at them, then Blink in and Scream of Pain. If things start going badly, blink out to a safer distance and dish out damage from the fringes of the fights with Shadow Strike and autoattacks. Punish anybody who gets near with Scream of Pain. If the fight goes on for more than 30 seconds, you're in luck; you get to ult twice in one fight, almost guaranteeing a victory.
One last thing: Blink far ahead of your team if you're pushing against a dead enemy team (ONLY if the enemy is dead, though). This allows you to clear the entire creep wave yourself, as your ultimate leaves the creeps very low for some greedy 
Shadow Shaman to wipe out with an 
Ether Shock. Don't let that happen (or do, it's up to you).
Scenario 1: You can't get rich
Aghanim's Scepter is expensive. Before you have it, you are pretty weak, and it's sometimes hard to get over the hump to buying it. Orchid Malevolence can be very nice here, as the parts are all fairly cheap and give you a lot of mid-game potential. Additionally, the silence helps your ganks out a ton and allows you to get fairly rich off your opponents.
Scenario 2: You're being shut down. Hard.
They have a 
Lion. Or a 
Silencer. You can't do your thing; you get silenced, blown up, and die every time you leave the safety of your fountain. For this, Scythe of Vyse or Orchid Malevolence is the item for you. If you are struggling early game, get the Orchid Malevolence, and turn the tables on your oppressors; if you got a solid early game lead, but realize now that their Silencer just came online, consider the Scythe of Vyse for the heavier disable.
Scenario 3: They just don't die!
Their team is made of meat, and lots of it. You're casting everything, and they just aren't dead yet. Here, consider the Orchid Malevolence or the Dagon. With Orchid Malevolence, you can get that extra 30% damage; with Dagon, your combo gains another few hundred damage. Either way, these items can get you back in control of your fights and ganks.
Scenario 4: Out of mana.
You're on the run. Nowhere to hide. Ahead, you see a cliff. If only you could Blink onto it. Unfortunately, you're out of mana. That sucks. If it's early game, consider getting an Enchanted Mango or two. The burst mana can be a godsend for finishing ganks or escaping the jaws of death. If it's later in the game but you can't get to that Octarine Core or Bloodstone, pick up a Scythe of Vyse. In addition to the wonderful utility granted by the disable, it gives you a nice bunch of int for you to play with.
Scenario 5: It just isn't working. None of it is working.
You tried, you really did. But you're still just a useless hero. You'd be better off disconnecting. Never fear; you can still be a credit to team! Buy a Necronomicon. It's old school, but it still works; rather than fighting, push down towers. Clear out lanes. Create space for your team.
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