No, the orc in Ellinia always has the ancient skull, not the pain skull. I have only found the pain skull twice in three full games, once at the dwarven necro's house, and once in Karador's castle after i beat him.
The first time I beat Karador I find the pain skull available in Neocrom. I initially thought it must have something to do with Karador until I bother myself to read the description.
Hybrid Mode
