Pain Attunement - Path of Exile

Pain Attunement is a keystone passive skill. It grants 30% more spell damage when the character is on low life.

  • 30% more Spell Damage when on Low Life

Low life is a condition that applies when life falls below 35%.

Using gems with a flat percent of reserved mana, one can maintain precisely 65% health reserved by supporting it with reduced mana reservation nodes from the passive skill tree, Blood Magic Support Blood Magic Support and maybe also Enlighten Support Enlighten Support across several permutations.

Here is a guide to maintain low life state.

Pain Attunement PoE

Buy PoE Currency Cheap

  • Buy Cheap PoE Currency Instant Delivery using a 6% off coupon: poeitems. Mulefactory is a reliable PoE currency website that offers cheap Exalted Orbs, Chaos Orbs, PoE Items, etc. Payments: PayPal, Skrill, BitCoin.

Blood Magic Support

Blood Magic Support Blood Magic Support causes linked skills to be paid using life instead of mana. Linking auras or other mana-reserving skills to Blood Magic Support Blood Magic Support is an easy way to trigger the low life condition.

Reserve more than 65% of your life

Low life is defined as having 35% or less life remaining. This state can be achieved by reserving 65% (or more) of the player’s life pool.

If doing the above, your Light radius will be dramatically reduced. The Arcane Vision notable, found directly adjacent to Pain Attunement, counteracts this downside.

Chaos Inoculation(CI)

Low life conditions will never trigger while CI is enabled. Effects such as Pain Attunement and On Low Life mods on gear will not activate. For these effects, you must have 35% or less of your current maximum life. Chaos Inoculation sets your maximum life to 1.

With the exception of using Coward’s Legacy Coward’s Legacy(You count as on Low Life while you are Cursed with Vulnerability Vulnerability), where the player may simultaneously be on low life and have Chaos Inoculation.

How to get Pain Attunement?

1. Passive Skill Tree

Pain Attunement is a standalone keystone located on the inner layer of the transition area between Witch and Shadow.

Class Distance from start
Shadow 7
Witch 7
Scion 11
Templar 16
Ranger 17
Duelist 21
Marauder 21

2. Pain Attunement Uniques

These unique items have the Pain Attunement modifier, which provides the same effect as this keystone. Taking the keystone in addition to equipping one of these items will impart no additional benefit.

Item Base Item Lvl. Category Stats
Skin of the Lords Skin of the Lords Simple Robe 1 Body Armour Item has no level requirement and Energy Shield (Hidden)
Sockets cannot be modified
+1 to Level of Socketed Gems
100% increased Global Defences
You can only Socket Corrupted Gems in this item
Item has 6 Sockets and is fully linked (Hidden)

<Random Keystone>


Crown of Thorns Crown of Thorns Vine Circlet 3 Helmet +(60-80) to maximum Energy Shield
Reflects 5 Physical Damage to Melee Attackers
+5 Physical Damage taken from Attack Hits
Pain Attunement
Martyr’s Crown Martyr’s Crown Vine Circlet 52 Helmet +(60-80) to maximum Energy Shield
+(110-130) to maximum Energy Shield
Reflects 5 Physical Damage to Melee Attackers
+5 Physical Damage taken from Attack Hits
Pain Attunement

Related PoE Currency, Gem, Skills Build Guide