The phrase "twists the knife in the wound" is typically used to describe a painful and cruel action that makes a bad situation worse. There are a number of synonyms for this phrase that convey similar meanings. One such synonym is "pouring salt on the wound," which suggests the infliction of additional pain on an already injured area. Another is "rubbing salt in the wound," which implies a deliberate attempt to exacerbate an already difficult situation. Other synonyms include "adding insult to injury" and "making matters worse." Ultimately, each of these phrases describes an action that causes unnecessary pain and suffering, often through intentionally cruel or thoughtless behavior.