Therapy

For other uses, seeTherapy (disambiguation).

Therapy
Children undergoing physical therapy. (polio)
MeSH	D013812

Atherapyormedical treatmentis the attempted remediation of ahealthproblem, usually following amedical diagnosis.Both words,treatmentandtherapy,are often abbreviatedtx,Tx,orT_x.

As a rule, each therapy hasindicationsandcontraindications.There are many different types of therapy. Not all therapies areeffective.Many therapies can produce unwantedadverse effects.

Treatmentandtherapyare often synonymous, especially in the usage ofhealth professionals.However, in the context ofmental health,the termtherapymay refer specifically topsychotherapy.

Semantic field

The wordscare,therapy,treatment,andinterventionoverlap in asemantic field,and thus they can besynonymousdepending oncontext.Moving rightward through that order, theconnotativelevel ofholismdecreases and the level of specificity (toconcreteinstances) increases. Thus, inhealth-carecontexts (where itssensesare alwaysnoncount), the wordcaretends to imply a broad idea of everything done to protect or improve someone's health (for example, as in the termspreventive careandprimary care,which connote ongoing action), although it sometimes implies a narrower idea (for example, in the simplest cases ofwound careorpostanesthesia care,a few particular steps are sufficient, and the patient's interaction with the provider of such care is soon finished). In contrast, the wordinterventiontends to be specific and concrete, and thus the word is oftencountable;for example, one instance ofcardiac catheterizationis oneinterventionperformed, andcoronary care(noncount) can require a series of interventions (count). At the extreme, the piling on of such countable interventions amounts tointerventionism,a flawed model of care lacking holisticcircumspection—merely treatingdiscreteproblems (in billable increments) rather than maintaining health.Therapyandtreatment,in the middle of the semantic field, can connote either the holism ofcareor the discreteness ofintervention,with context conveying the intent in each use. Accordingly, they can be used in both noncount and count senses (for example,therapy forchronic kidney diseasecan involve severaldialysistreatments per week).

The wordsaceologyandiamatologyare obscure and obsolete synonyms referring to the study of therapies.

The English wordtherapycomes via LatintherapīafromGreek:θεραπείαand literally means "curing" or "healing".The termtherapeusisis a somewhat archaic doublet of the wordtherapy.

Types of therapies

By chronology, priority, or intensity

Levels of care

Levels of care classifyhealth careinto categories of chronology, priority, or intensity, as follows:

• Urgent carehandles health issues that need to be handled today but are not necessarily emergencies; the urgent care venue can send a patient to the emergency care level if it turns out to be needed.
  • In the United States (and possibly various other countries),urgent carecenters also serve another function as their other main purpose: U.S.primary carepractices have evolved in recent decades into a configuration whereby urgent care centers provide portions of primary care that cannot wait a month, because getting an appointment with the primary care practitioner is often subject to a waitlist of 2 to 8 weeks.
• Emergency carehandlesmedical emergenciesand is a first point of contact or intake for less serious problems, which can be referred to other levels of care as appropriate.
• Intensive care,also calledcritical care,is care for extremely ill or injured patients. It thus requires high resource intensity, knowledge, and skill, as well as quickdecision making.
• Ambulatory careis care provided on anoutpatientbasis. Typically patients can walk into and out of the clinic under their own power (hence "ambulatory" ), usually on the same day.
• Home careis care at home, including care from providers (such as physicians, nurses, and home health aides) makinghouse calls,care fromcaregiverssuch as family members, and patientself-care.
• Primary careis meant to be the main kind of care in general, and ideally amedical homethat unifies care across referred providers.
• Secondary careis care provided by medical specialists and other health professionals who generally do not have first contact with patients, for example,cardiologists,urologistsanddermatologists.A patient reaches secondary care as a next step fromprimary care,typically by provider referral although sometimes by patient self-initiative.
• Tertiary careis specialized consultative care, usually forinpatientsand on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as atertiary referral hospital.
• Follow-up care is additional care during or afterconvalescence.Aftercare is generally synonymous with follow-up care.
• End-of-life careis care near the end of one's life. It often includes the following:
  • Palliative careissupportive care,most especially (but not necessarily) near the end of life.
  • Hospicecare is palliative care very near the end of life whencureis very unlikely. Its main goal is comfort, both physical and mental.

Lines of therapy

Treatment decisions often follow formal or informalalgorithmicguidelines. Treatment options can often be ranked or prioritized intolines of therapy:first-line therapy,second-line therapy,third-line therapy,and so on.First-line therapy(sometimes referred to asinduction therapy,primary therapy,orfront-line therapy)is the first therapy that will be tried. Its priority over other options is usually either: (1) formally recommended on the basis ofclinical trialevidence for its best-available combination of efficacy, safety, and tolerability or (2) chosen based on the clinical experience of the physician. If a first-line therapy either fails to resolve the issue or produces intolerableside effects,additional (second-line) therapies may be substituted or added to the treatment regimen, followed by third-line therapies, and so on.

An example of a context in which the formalization of treatment algorithms and the ranking of lines of therapy is very extensive ischemotherapy regimens.Because of the great difficulty in successfully treating some forms of cancer, one line after another may be tried. Inoncologythe count of therapy lines may reach 10 or even 20.

Often multiple therapies may be tried simultaneously (combination therapyor polytherapy). Thuscombination chemotherapyis also called polychemotherapy, whereas chemotherapy with one agent at a time is called single-agent therapy or monotherapy.

Adjuvant therapyis therapy given in addition to the primary, main, or initial treatment, but simultaneously (as opposed to second-line therapy).Neoadjuvant therapyis therapy that is begun before the main therapy. Thus one can consider surgical excision of a tumor as the first-line therapy for a certain type and stage of cancer even though radiotherapy is used before it; the radiotherapy is neoadjuvant (chronologically first but not primary in the sense of the main event).Premedicationis conceptually not far from this, but the words are not interchangeable; cytotoxic drugs to put a tumor "on the ropes" before surgery delivers the "knockout punch" are called neoadjuvant chemotherapy, not premedication, whereas things like anesthetics or prophylactic antibiotics before dental surgery are called premedication.

Step therapyor stepladder therapy is a specific type of prioritization by lines of therapy. It is controversial inAmerican health carebecause unlike conventionaldecision-makingabout what constitutes first-line, second-line, and third-line therapy, which in the U.S. reflects safety and efficacy first and cost only according to the patient's wishes, step therapy attempts to mix cost containment by someone other than the patient (third-party payers) into the algorithm.Therapy freedomand the negotiation betweenindividual and group rightsare involved.

By intent

Therapy type	Description
abortive therapy	A therapy that is intended to stop a medical condition from progressing any further. A medication taken at the earliest signs of a disease, such as ananalgesictaken at the first symptoms of amigraine headacheto prevent it from getting worse, is an abortive therapy. Compareabortifacients,which abort a pregnancy.
bridge therapy	A therapy thatfigurativelyprovides a bridge to another step or phase, crossing over some immediate chasm (challenge), in contrast withdestination therapy,which is the final therapy in cases where clinically appropriate.
consolidation therapy	A therapy given to consolidate the gains frominduction therapy.In cancer, this means chasing after any malignant cells that may be left.
curative therapy	A therapy withcurative intent,that is, one that seeks tocurethe root cause of a disorder. (also called etiotropic therapy)
definitive therapy	A therapy that may be final, superior to others,curative,or all of those.
destination therapy	A therapy that is the final destination rather than abridgeto another therapy. Usually refers toventricular assist devicesto keep the existing heart going, not just untilheart transplantationcan occur, but for the rest of the patient's life expectancy.
empiric therapy	A therapy given on an empiric basis; that is, one given according to a clinician's educated guess despite uncertainty about the illness's causative factors. For example, empiric antibiotic therapy administers abroad-spectrum antibioticimmediately on the basis of a good chance (given the history, physical examination findings, and risk factors present) that the illness is bacterial and will respond to that drug (even though the bacterial species or variant is not yet known).
gold standard therapy	A therapy that isdefinitive,just as agold standard diagnostic testis a definitive test.
investigational therapy	Anexperimentaltherapy. Use of experimental therapies must be ethically justified, because by definition they raise the question ofstandard of care.Physicians have autonomy to provide empirical care (such asoff-labelcare) according to their experience and clinical judgment, but the autonomy has limits that precludequackery.Thus it may be necessary to design aclinical trialaround the new therapy and to use the therapy only per a formalprotocol.Sometimes shorthand phrases such as "treated on protocol" imply not just "treated according to a plan" but specifically "treated with investigational therapy".
maintenance therapy	A therapy taken duringdisease remissionto prevent relapse.
palliative therapy	Seesupportive therapyfor connotative distinctions.
preventive therapy (prophylactic therapy)	A therapy that is intended toprevent a medical conditionfrom occurring (also called prophylaxis). For example, manyvaccinesprevent infectious diseases.
salvage therapy(rescue therapy)	A therapy tried after others have failed; it may be a "last-line"therapy.
stepdown therapy	Therapy that tapers the dosage gradually rather than abruptly cutting it off. For example, a switch from intravenous to oral antibiotics as an infection is brought under control steps down the intensity of therapy.
supportive therapy	A therapy that does not treat or improve the underlying condition, but rather increases the patient's comfort, also calledsymptomatic treatment(see there for more information).For example, supportive care for flu, colds, or gastrointestinal upset can include rest, fluids, andover-the-counterpain relievers; those things do not treat the cause, but they treat the symptoms and thus provide relief. Supportive therapy may be palliative therapy (palliative care). The two terms are sometimes synonymous, but palliative care often specifically refers to serious illness andend-of-life care.Therapy may be categorized as havingcurative intent(when it is possible to eliminate the disease) orpalliative intent(when eliminating the disease is impossible and the focus shifts to minimizing the distress that it causes). The two are oftencontradistinguished(mutually exclusive) in some contexts (such as themanagement of some cancers), but they are not inherently mutually exclusive; often therapy can be both curative and palliative simultaneously.Supportive psychotherapyaims to support the patient by alleviating the worst of the symptoms, with the expectation thatdefinitive therapycan follow later if possible.
systemic therapy	A therapy that issystemic.In the physiologicalsense,this means affecting the whole body (rather than being local or locoregional), whether viasystemic administration,systemic effect, or both.Systemic therapy in the psychotherapeutic senseseeks to address people not only on the individual level but also as people in relationships, dealing with the interactions of groups.

By therapy composition

Treatments can be classified according to the method of treatment:

Bymatter

• bydrugs:pharmacotherapy,chemotherapy(also,medical therapyoften means specifically pharmacotherapy)
• bymedical devices:implantation
  • cardiac resynchronization therapy
• by specificmolecules:molecular therapy(although most drugs are specific molecules,molecular medicinerefers in particular to medicine relying onmolecular biology)
  • by specificbiomoleculartargets:targeted therapy
    • molecular chaperone therapy
  • bychelation:chelation therapy
• by specificchemical elements:
  • bymetals:
    • byheavy metals:
      • bygold:chrysotherapy(aurotherapy)
      • byplatinum-containing drugs:platin therapy
    • bybiometals
      • bylithium:lithium therapy
      • bypotassium:potassium supplementation
      • bymagnesium:magnesium supplementation
      • bychromium:chromium supplementation;phonemic neurological hypochromium therapy
      • bycopper:copper supplementation
  • bynonmetals:
    • by diatomicoxygen:oxygen therapy,hyperbaric oxygen therapy (hyperbaric medicine)
      • transdermal continuous oxygen therapy
    • by triatomic oxygen (ozone):ozone therapy
    • byfluoride:fluoride therapy
    • by other gases:medical gas therapy
• bywater:
  • hydrotherapy
  • aquatic therapy
  • rehydration therapy
    • oral rehydration therapy
  • water cure (therapy)
• by biological materials (biogenic substances,biomolecules,biotic materials,natural products), including theirsyntheticequivalents:biotherapy
  • by wholeorganisms
    • byviruses:virotherapy
    • bybacteriophages:phage therapy
    • by animal interaction:seeanimal interactionsection
  • by constituents or products of organisms
    • byplantparts or extracts (but many drugs are derived from plants, even when the termphytotherapyis not used)
      • scientific type:phytotherapy
      • traditional (prescientific) type:herbalism
    • by animal parts:quackeryinvolving shark fins, tiger parts, and so on, often drivingthreatorendangermentof species
    • bygenes:gene therapy
      • gene therapy for epilepsy
      • gene therapy for osteoarthritis
      • gene therapy for color blindness
      • gene therapy of the human retina
      • gene therapy in Parkinson's disease
    • byepigenetics:epigenetic therapy
    • byproteins:protein therapy(but many drugs are proteins despite not being called protein therapy)
    • byenzymes:enzyme replacement therapy
    • byhormones:hormone therapy
      • hormonal therapy (oncology)
      • hormone replacement therapy
        • estrogen replacement therapy
        • androgen replacement therapy
        • hormone replacement therapy (menopause)
        • transgender hormone therapy
          • feminizing hormone therapy
          • masculinizing hormone therapy
      • antihormone therapy
        • androgen deprivation therapy
    • by wholecells:cell therapy(cytotherapy)
      • bystem cells:stem cell therapy
      • byimmune cells:see immune system products below
    • byimmune systemproducts:immunotherapy,host modulatory therapy
      • byimmune cells:
        • T-cell vaccination
        • cell transfer therapy
        • autologous immune enhancement therapy
        • TK cell therapy
      • byhumoral immune factors:antibody therapy
        • by wholeserum:serotherapy, includingantiserumtherapy
        • byimmunoglobulins:immunoglobulin therapy
          • bymonoclonal antibodies:monoclonal antibody therapy
  • byurine:urine therapy(some scientific forms; many prescientific or pseudoscientific forms)
  • byfoodanddietarychoices:
    • medical nutrition therapy
    • grape therapy(quackery)
• bysalts(but many drugs are the salts of organic acids, even when drug therapy is not called by names reflecting that)
  • bysaltsin the air
    • by natural dry salt air: "taking the cure" indesertlocales (especially common in prescientific medicine; for example, one 19th-century way to treat tuberculosis)
    • by artificial dry salt air:
      • low-humidity forms ofspeleotherapy
      • negative air ionization therapy
    • bymoist salt air:
      • by natural moist salt air:seaside cure(especially common in prescientific medicine)
      • by artificial moist salt air: water vapor forms ofspeleotherapy
  • bysaltsin the water
    • bymineral water:spa cure( "taking the waters" ) (especially common in prescientific medicine)
    • byseawater:seaside cure(especially common in prescientific medicine)
• byaroma:aromatherapy
• by other materials with mechanism of action unknown
  • by occlusion with duct tape:duct tape occlusion therapy

Byenergy

• byelectric energyaselectric current:electrotherapy,electroconvulsive therapy
  • Transcranial magnetic stimulation
  • Vagus nerve stimulation
• bymagnetic energy:
  • magnet therapy
  • pulsed electromagnetic field therapy
  • magnetic resonance therapy
• byelectromagnetic radiation(EMR):
  • bylight:light therapy(phototherapy)
    • ultraviolet light therapy
      • PUVA therapy
    • photodynamic therapy
      • photothermal therapy
      • cytoluminescent therapy
    • blood irradiation therapy
    • bydarkness:dark therapy
    • bylasers:laser therapy
      • low level laser therapy
  • bygamma rays:radiosurgery
    • Gamma Knife radiosurgery
    • stereotactic radiation therapy
    • cobalt therapy
  • byradiationgenerally:radiation therapy(radiotherapy)
    • intraoperative radiation therapy
    • by EMRparticles:
      • particle therapy
        • proton therapy
        • electron therapy
          • intraoperative electron radiation therapy
          • Auger therapy
        • neutron therapy
          • fast neutron therapy
          • neutron capture therapy of cancer
    • byradioisotopesemitting EMR:
      • bynuclear medicine
      • bybrachytherapy
  • quackery type:electromagnetic therapy (alternative medicine)
• bymechanical:manual therapyasmassotherapyand therapy byexerciseas inphysical therapy
  • inversion therapy
• bysound:
  • byultrasound:
    • ultrasoniclithotripsy
      • extracorporeal shockwave therapy
    • sonodynamic therapy
  • bymusic:music therapy
• bytemperature
  • byheat:heat therapy(thermotherapy)
    • by moderately elevated ambient temperatures:hyperthermia therapy
      • by dry warm surroundings:Waon therapy
      • by dry or humid warm surroundings:sauna,includinginfrared sauna,forsweat therapy
  • bycold:
    • by extreme cold to specific tissue volumes:cryotherapy
    • by ice and compression:cold compression therapy
    • by ambient cold:
      • hypothermia therapy for neonatal encephalopathy(in newborns)
      • targeted temperature management(therapeutic hypothermia, protective hypothermia)
  • by hot and cold alternation:contrast bath therapy

By procedure and human interaction

• Surgery
• bycounseling,such aspsychotherapy(see also:list of psychotherapies)
  • systemic therapy
  • bygroup psychotherapy
• bycognitive behavioral therapy
  • bycognitive therapy
  • bybehaviour therapy
    • bydialectical behavior therapy
  • bycognitive emotional behavioral therapy
• bycognitive rehabilitation therapy
• byfamily therapy
• byeducation
  • bypsychoeducation
  • byinformation therapy
• byspeech therapy,physical therapy,occupational therapy,vision therapy,massagetherapy,chiropracticoracupuncture
• bylifestyle modifications,such as avoidingunhealthy foodor maintaining a predictablesleepschedule
• bycoaching

By animal interaction

• bypets,assistance animals,orworking animals:animal-assisted therapy
  • byhorses:equine therapy,hippotherapy
  • bydogs:pet therapy withtherapy dogs,includinggrief therapy dogs
  • bycats:pet therapy withtherapy cats
• byfish:ichthyotherapy(wading with fish),aquarium therapy(watching fish)
• bymaggots:maggot therapy
• byworms:
  • by internal worms:helminthic therapy
  • byleeches:leech therapy
• byimmersion:animal bath

Bymeditation

• bymindfulness:mindfulness-based cognitive therapy

Byreading

• bybibliotherapy

Bycreativity

• by expression:expressive therapy
  • bywriting:writing therapy
    • journal therapy
• byplay:play therapy
• byart:art therapy
  • sensory art therapy
  • comic book therapy
• bygardening:horticultural therapy
• bydance:dance therapy
• bydrama:drama therapy
• byrecreation:recreational therapy
• bymusic:music therapy

Bysleepingand waking

• bydeep sleep:deep sleep therapy
• by sleep deprivation:wake therapy

See also

• Biophilia hypothesis
• Classification of Pharmaco-Therapeutic Referrals
• Compassion-focused therapy
• Emotionally focused therapy
• Greyhound therapy
• Inverse benefit law
• List of therapies
• Mature minor doctrine
• Medication
• Medicine
• Nutraceutical
• Prevention
• Psychedelic therapy
• Therapeutic inertia
• Therapeutic nihilism,the idea that treatment is useless
• Treatment as prevention

External links

• The dictionary definition oftherapyat Wiktionary
• "Chapter Nine of the Book of Medicine Dedicated to Mansur, with the Commentary of Sillanus de Nigris"is a Latin book byRhazes,from 1483, that is known for its ninth chapter, which is about therapeutics