Hi Ben, If the pain is not being eased then you might need to better define the type of pain you are experiencing.
I find that I experience a few different types of pain.
The intense spasm from the tightness of the sphincter which usually comes on shortly after a bowel motion (BM) and can last for hours. The sharp burning pain of the open wound of the fissure when passing a BM. The oppressive pressure of a descending stool on the fissure and sphinter.
This is relieved for me by nurafen (ibrufren) before a BM, Vaseline around the anus to aid a smooth passage of BM, cleaning with witchhazel soaked baby wipes (not toilet paper) warm to hot baths immediately after each BM (and when whenever the spasms are not relieved), Movicol (Miralax) one sachet in the morning, 3litres of water a day, Prune Juice, Oatmeal, GTN ointment and more recently Botox injections.
I also experience an irrisistable urge to scratch the area which I have relieved with a cortisone cream.
When using the GTN I experienced pounding headaches and throbbing at the fissure site. Both due to increased blood flow to the area. I dealt with this by applying a much smaller than recommended amount more frequently and making sure I could sit or lay down for a while after application.
Does any of this help? I hope so.
If you find the pain is the same after GTN it may not be having affect. But if you find that the pain if due to increased blood flow you may need to reduce the amount slightly and take some analgesia to offset it.
The secret to healing is a combination of many things being understanding the process of the infliction,diet, ointment, analgesia, water, stool softeners etc.
It is also vital to take control of you thoughts. Practise some relaxation techniques. try to take things one step at a time and look at things logically without worry.
we have all been at the place you have been and can reassure you that it does get better.
Healing wished to You. XX Pia