Thats why your doc suggested botox or surgery because thats the treatment they usually suggest if the creams don't work.Maybe you should go ahead with the botox and see if it works.That may or may not work but what do you have to lose at this point.If your in that much agony LIS would be the way to go since it's the most successful treatment.Easier said for me coming from a guy who took a 22 cal.to the neck and was in a colma for a week and was in pain for 6 months.When my fissure got pretty bad I wanted the surgery because I'm no stranger to surgery and pain and I wanted my ordeal to be over with but good for me I didn't because nitro worked for me.