No laughs: New technique helps ticklish patients

Hand with feathering and foot (istock)

For ticklish people, a routine doctor's exam can lead to lots of squirming and giggling, which is not only uncomfortable for these patients but also can make it harder for doctors to examine them. But now, doctors in England may have come up with an innovative solution to this problem.

The new technique calls for creating a "hand sandwich" so that doctors can examine their ticklish patients without any difficulty or unwanted laughter, according to a letter to the editor published online today (March 9) in The New England Journal of Medicine.

To perform this technique, the examiner places the fingertips of one hand directly on the patient's skin in a sensitive area, such as the underarms. Next, the patient places the fingertips of his or her hand on top of the examiner's fingertips. To complete the "hand sandwich," the examiner places a second hand on top of the patient's hand, the authors said.

In this position, the examiner's top hand can actively guide the movement over the surface of the patient's skin while the examiner's bottom hand touches it directly. The patient is instructed to match the direction and degree of pressure of the examiner's top hand with his or her own hand.

The "hand sandwich" seems to work because patients can predict the movement of the examiner's hand as it applies pressure to the skin, which makes them feel like they are initiating, and effectively controlling, the movement with their own hand, said Dr. Christopher Dobson, the lead author of the letter and a consulting dermatologist at Royal Preston Hospital in Preston, England.

The technique allows patients to anticipate the touch sensation of the examiner's hand without eliciting a ticklish response because it's generally not possible for people to tickle themselves, he said. In other words, the "hand sandwich" may help fool the patient's brain into thinking the pressure is coming from his or her own hand, thus reducing the ticklish sensation, Dobson said.

Consequently, a doctor can perform an exam that requires touch without someone tensing up, squirming, laughing or causing a diagnosis to be missed. [Which Animals Are Ticklish?]

Taming ticklishness

Touch is an important diagnostic tool during a physical exam, but it can be challenging for health practitioners to do so when a patient is ticklish.

It's unclear exactly why people are ticklish. One theory suggests that ticklishness is the brain's reaction to the sensation of an unexpected touch. But because there is no surprise factor when people attempt to tickle themselves, the brain knows what's coming, and the ticklish response is dampened, Dobson said.

Ticklishness is much more common in children than in adults, Dobson said. In his own dermatology practice, being ticklish as an adult can lead to greater anxiety in patients, causing people's muscles to tense up during an exam and thus making it harder for a doctor to properly feel that person's lymph nodes.

In fact, the "hand sandwich" was originally developed as a method for examining the lymph-node basins — the hollow areas under the armpits, just above the collarbone or near the groin, for example — of ticklish patients with skin cancer, Dobson told Live Science.

Dobson said he has used the technique on a small number of his adult patients who, because of their ticklishness, often have to make repeated visits to the dermatology clinic to be examined."It's been very effective" in these individuals, he said. (The effectiveness of the technique is based on anecdotal evidence at this point, and has not yet been tested in a study.)

Nor has the technique been tested in children, Dobson said. But he suspects it would also work in kids, although there may be some limitations due to young children's smaller hand size.

Besides the technique's use for examining the lymph nodes in people with skin cancer, Dobson has found it to be a less-painful approach for examining ticklish adults with tender groins. This opens up the possibility that this hands-on approach might also be useful for examining a tender abdomen or, in a modified form, for any patient suffering from pain or tenderness during an ultrasound exam, he said.

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