The phrase "twisting knife" can be replaced with several similar options to convey a similar meaning. Some synonyms for the term are "stabbing knife," "slicing knife," or "jabbing knife." You can replace "twist" with words like "inflict," "assail," or "wound," creating phrases such as "inflicting knife" or "assailing knife." Other options can include "agony knife," emphasizing the pain inflicted, or "betrayer's knife," highlighting the feeling of betrayal that the phrase suggests. In any case, each variation carries its own meaning but shares the sense of pain and discomfort that the original phrase expresses.