There have probably been quite a few posts about pain relief, but thought I would delve into AF'ers brains right now and see who uses pain killers, and if so what.
So far, in all the pain of this whole wretched fissure saga, I have taken nothing. I am not supposed to take ibuprofen as it does not mix well with my BP medication. But, the pain has been getting so bad that was thinking of taking a small amount of Tylanol that comes in liquid form. Not taken any thing before because of the fear of getting an 'upset stomach' if I do. Which I have today, and has got the fissure buzzing pain again. Would just like to be pain free sometimes.

It seems a shame to me to take a painkiller that affects your whole body and still barely takes the edge off anal/rectal pain. I haven't found a good one.
Maybe there's something topical though, like lidocaine or even witch hazel. I have used witch hazel (the liquid kind, meant to be a facial toner) and it was helpful for cutting the pain somewhat. I can't advise about Tylenol because for me it works about as well as taking a sugar pill--absolute useless garbage that is. It has never worked for me, for any pain, throughout my entire life. It may work for others, we all have different metabolisms. Anything may be worth a try if your doctor says it's ok.
Do you take any stool softeners? Miralax has been the #1 most helpful thing, better than the nitro even.
Hope you get to feeling better!

You could try it if you feel it won't hurt you, but I had the same experience as Alpine - paracetamol and ibuprofen didn't make a dent when the pain was bad... maybe it helped a little later, when I just had the dull ache (I took ibuprofen for cramps, and I think the dull butt ache lessened a little then too, that's how I discovered that).
When the pain was bad, the only thing that helped me was heat (wheat bag and baths) - and pretty much biting a bullet for an hour after the BM.
And I'm also with alpine on the miralax - in the beginning of all this, I thought my stools were soft, but I think they were still causing me a lot of pain. After they became softer with the miralax, that's when the severe spasms started going away.
Sorry you are in pain... When is your CRS appointment?

I use ibuprofen and extra strength robaxacet, 1/2 hour before BM, every five hours after, usually I don't need anything by evening but my heating pad. Naproxen helped for awhile but eventually I got used to it. The heating pad saved my life and bought a cheap heated seat pad for my car $10 Canadian tire for those of u in Canada, makes driving almost bearable! Good luck hope u find a good combo!

I've used just about everything under the sun. In the beginning, I tried topical lidocaine, dibucaine, and a couple other ones. None of those helped at all.
I also took Valium (diazepam) for spasm relief at one point. That was mildly to moderately effective, but then I ended up dependent on it and still haven't been able to quit it completely to this day. Lots of other folks here have taken it without problems though.
When my fissure was at its peak, I took Vicodin (hydrocodone plus Tylenol) and also Percocet (oxycodone plus Tylenol) and both worked well. But they do have lots of side effects, including constipation. That's a non issue for me since I take Miralax every day, but could be a BIG consideration if your stool softener isn't up to the task or if you have a sensitive stomach in general. But I'll tell you what: there was one day when I took a dump and couldn't even get up from the toilet. The pain was THAT bad. I took a bunch of ibuprofen, Valium, plus Tylenol and there was ZERO relief. I ended up getting carried to the ER by my coworkers (very embarrassing), where they gave me Percocet and the spasms went away completely. Since that day, I swear by the "big guns" of narcotic painkillers for truly severe pain. Some cases may not warrant them, but for pain that nothing else touches, there's no substitute IMO.