I've had painful hemmeroids on the outside a couple of times and once a thrombosed hemmeroid which was extremely painful. The first time I tried many cortisone creams, suppositories and oitments but I think I overused them because I ended up with severe proctitis from overuse.
The second time I increased my metamucil-fiber, took as many hot baths with epsom salts or sea salt, cleaned up the junk in my diet and drank as much water as possible, wore support socks which help the vericose viens and constantly lubricated my rectum with vitamin e oil to help with healing and to help the bms move easier. I took 2 extra strength tylenol every 4 hours for the pain. Witch hazel on a cotton ball and placed it on the hemmeroid and left it there for a while to help with the itching. Try to keep your feet up when you can the longer on your feet the more painful they get and thats where the support socks help.