The game revolves around a young man named Daniel Garner ( Cam Clarke), who is happily married to his wife Catherine ( Vanessa Marshall). It includes classic modes like Deathmatch and Capture-the-Flag. The game also features a multiplayer component. Each equipped card provides different bonuses for a small amount of time (30 seconds), like powered-up weapons or slow motion. The game presents an option to complete a special task each level, which results in the player getting a 'tarot card', a rare, hard-to-obtain bonus. There are five 'boss' levels where the player fights a boss. Monsters are also very different, with new ones almost every level.

The levels include castles, monasteries, an opera house, graveyards, and more. One of the game's most important aspects is its diversity, with each level presenting a new location with various themes and graphic styles. Fighting monsters often occurs in mass battles, where the player has to fight an attack by a swarm of enemies in a large room, while the exits shut and heavy metal music plays in the background, and after such a battle, the player passes a 'checkpoint' which advances the game, the exits open up again, and the music returns to the usual softer tune played in the level.

The player's objective is to get through each level, from start to finish, by slaughtering hundreds of monsters. The game is divided into five chapters, each about five levels long. The game is inspired by first-person shooters such as Quake, Doom and Serious Sam, with the emphasis on killing large numbers of monsters. The game was particularly well-received for its multiplayer experience and was featured for two seasons on the Cyberathlete Professional League's World Tour. The game's single player campaign follows a dead man in Purgatory who is offered a deal to defeat the invading forces of Lucifer's army in exchange for being allowed to enter Heaven. Painkiller is a first-person shooter video game developed by Polish game studio People Can Fly and published by DreamCatcher Interactive in April 2004 for Microsoft Windows and ported to Xbox in 2006.

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