The Healing Burn

Eric Lis

In a medieval fantasy setting, a chili pepper might be one the scariest things you could ever see an alchemist holding.

I'm not much of a lover of spicy foods -- like my Russian and Polish ancestors, my tastes run more towards salt and sweet than hot -- but like many people, I think they're fascinating. More precisely, I'm very interested in the chemical that makes chili peppers feel "hot" even though they wouldn't set off a thermometer anywhere in the world. Chili peppers contain a molecule called "capsaicin," so named because it was originally extracted from the Capsicum genus of plants, which includes the common bell peppers, the jalapeno, and a number of other species readily recognizable around the world. Capsaicin is itself the prototypical members of a family of molecules called the "capsaicinoids," all of which contribute to the "hot" effect of various foods to varying degrees. Capsaicinoids are big in modern research because they seem to have some potential for a number of medical and non-medical uses far beyond the gustatory, and some of these could reasonably carry over into your game, especially in any setting where Clarkeian alchemy is common.

Capsaicin was a relatively early discovery in the golden age of extraction chemistry. It was partially isolated for the first time in the early 1800's, but it was only in the last years of that century that a pure form was extracted. If your game adheres strictly to period-realistic technology, then pure capsaicin probably isn't available in a fantasy setting, because the technology and skills to extract it don't exist yet, but for the uses I'll discuss below, an extract probably doesn't have to be absolutely pure, and given the stuff that alchemists in most fantasy settings can whip up using nothing more than an alembic and a witty retort. Although chili peppers and other hot spices have been used medically for thousands of years in many parts of the world, this was primarily as a digestive aid and other such pragmatic, hard-to-test uses. Modern uses of chili peppers can be broadly split into two categories: relieving pain, and causing pain. As far as the question of purity and anachronistic use goes, as is often the case, it's a lot easier to refine something into a form that causes pain than a form that relieves it.

Capsaicin is being carefully studied today as a pain reliever. For the most part, capsaicin is being used to treat pain that comes directly from nerves (or "neuropathic pain"); while that's extremely important and fascinating work, it's not of any real interest to a gaming-oriented discussion, so if you'd like to know about how capsaicin might help your post-herpetic agony, I encourage you to read up on that on your own. There's another area of research where capsaicin is interesting, which is in the direct control of wound pain. This area is much less far along, so it's hard for me to make any really authoritative statements, but in recent years there have been a few studies which directly compared capsaicin to morphine for people who underwent surgery and found some very favourable results. Now, let me clarify that. First, as far as we know, you can't just give someone a pill full of capsaicin as a form of pain relief, and you wouldn't want to undergo surgery with nothing but capsaicin to help you, because you would feel every cut of the scalpel. Rather, capsaicin seems to have an interesting long-term effect when it directly contacts nerves. The mechanism has yet to be fully clarified, but our best understanding is that capsaicin's shape lets it trigger one of the body's main pain-sensors, and this tricks the nerve into sending an "I'm burning!" signal to the brain. Normally, something only triggers your pain sensor for a few seconds, and it isn't designed to keep being perpetually turned on. Since capsaicin just sits there, it seems as though it desensitizes the nerve, so that the nerve stops firing as much. Depending on how much capsaicin there is and how it gets applied, that nerve might stay desensitized for weeks, possibly as long as months. One use of capsaicin, therefore, is to allow people to ignore the pain of a wound and get back on their feet faster; a few studies have shown that when a bit of capsaicin is put into a wound at the end of a surgery, then in the weeks that follow, the patient complains of less post-operative pain, needs less pain medication, and feels able to resume physical activity sooner.

How does this translate into games? Hit point damage is often thought to represent a combination of actual tissue damage plus pain and suffering, and capsaicin seems to be able to reduce that pain and suffering. In parties without a healer, an alchemist might have the ability to apply capsaicin-impregnated field dressings to wounds which effectively speed hit point recovery. While a capsaicin bandage doesn't replace a cure potion, a storyteller might rule that when the party next gets their 8 hours of rest, they regain extra hit points, possibly as much as double. In turn, a particularly nasty storyteller might make the very sensible ruling that impure capsaicin extracts contain bacteria and other contaminants which somebody is now applying directly to their own wounds, and now players have to balance the benefits of regaining hit points tomorrow versus the risks of developing a wound infection three days from now. Decisions, decisions...

As for the other major alchemical use of capsaicin, any clever chemist will know that capsaicin is the active ingredient in most forms of pepper spray. It won't be hard for an imaginative player to come up with a few uses for it in combat, and a party may get some excellent use out of an alchemical substance which can be equally effective offensively and defensively depending on which of the body's openings it's applied to. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on June 22, 2014. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system