Therapy
Therapy
| Therapy | |
|---|---|
| MeSH | |
A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a diagnosis.
As a rule, each therapy has indications and contraindications. There are many different types of therapy. Not all therapies are effective. Many therapies can produce unwanted adverse effects.
Treatment and therapy are generally considered synonyms. However, in the context of mental health, the term therapy may refer specifically to psychotherapy.
| Therapy | |
|---|---|
| MeSH | |
Semantic field
The words care, therapy, treatment, and intervention overlap in a semantic field, and thus they can be synonymous depending on context. Moving rightward through that order, the connotative level of holism decreases and the level of specificity (to concrete instances) increases. Thus, in health care contexts (where its senses are always noncount), the word care tends to imply a broad idea of everything done to protect or improve someone's health (for example, as in the terms preventive care and primary care, which connote ongoing action), although it sometimes implies a narrower idea (for example, in the simplest cases of wound care or postanesthesia care, a few particular steps are sufficient, and the patient's interaction with that provider is soon finished). In contrast, the word intervention tends to be specific and concrete, and thus the word is often countable; for example, one instance of cardiac catheterization is one intervention performed, and coronary care (noncount) can require a series of interventions (count). At the extreme, the piling on of such countable interventions amounts to interventionism, a flawed model of care lacking holistic circumspection—merely treating discrete problems (in billable increments) rather than maintaining health. Therapy and treatment, in the middle of the semantic field, can connote either the holism of care or the discreteness of intervention, with context conveying the intent in each use. Accordingly, they can be used in both noncount and count senses (for example,
The words aceology and iamatology are obscure and obsolete synonyms referring to the study of therapies.
Types of therapies
By chronology, priority, or intensity
Levels of care
Levels of care classify health care into categories of chronology, priority, or intensity, as follows:
Emergency care handles medical emergencies and 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 called critical care, is care for extremely ill or injured patients. It thus requires high resource intensity, knowledge, and skill, as well as quick decision making.
Ambulatory care is care provided on an outpatient basis. Typically patients can walk into and out of the clinic under their own power (hence "ambulatory"), usually on the same day.
Home care is care at home, including care from providers (such as physicians, nurses, and home health aides) making house calls, care from caregivers such as family members, and patient self-care.
Primary care is meant to be the main kind of care in general, and ideally a medical home that unifies care across referred providers.
Secondary care is care provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists. A patient reaches secondary care as a next step from primary care, typically by provider referral although sometimes by patient self-initiative.
Tertiary care is specialized consultative care, usually for inpatients and 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 a tertiary referral hospital.
Follow-up care is additional care during or after convalescence. Aftercare is generally synonymous with follow-up care.
End-of-life care is care near the end of one's life. It often includes the following: Palliative care is supportive care, most especially (but not necessarily) near the end of life. Hospice care is palliative care very near the end of life when cure is very unlikely. Its main goal is comfort, both physical and mental.
Lines of therapy
Treatment decisions often follow formal or informal algorithmic guidelines. Treatment options can often be ranked or prioritized into lines of therapy: first-line therapy, second-line therapy, third-line therapy, and so on. First-line therapy (sometimes called induction therapy, primary therapy, or front-line therapy)[2] is the first therapy that will be tried. Its priority over other options is usually either: (1) formally recommended on the basis of clinical trial evidence 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 intolerable side 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 is chemotherapy regimens. Because of the great difficulty in successfully treating some forms of cancer, one line after another may be tried. In oncology the count of therapy lines may reach 10 or even 20.
Often multiple therapies may be tried simultaneously (combination therapy or polytherapy). Thus combination chemotherapy is also called polychemotherapy, whereas chemotherapy with one agent at a time is called single-agent therapy or monotherapy.
Adjuvant therapy is therapy given in addition to the primary, main, or initial treatment, but simultaneously (as opposed to second-line therapy). Neoadjuvant therapy is 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). Premedication is 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 therapy or stepladder therapy is a specific type of prioritization by lines of therapy. It is controversial in American health care because unlike conventional decision-making about 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 freedom and the negotiation between individual and group rights are 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 very 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 until aheart transplantcan 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 a clinical 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, many vaccinesprevent 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 instead increases the patient's comfort.[3]For example, supportive care for flu, colds, or gastrointestinal upset can include rest, fluids, andover the counterpain relievers; those things don't treat the cause, but they do treat the symptoms and thus provide relief.Supportive therapy may bepalliative therapy(palliative care). The two terms are sometimes synonymous, but palliative care oftenconnotesserious illness andend-of-life care, whereas supportive care is always connotatively neutral (it may be as simple as mere bedrest for the common cold).Therapy may be categorized as havingcurative intent(when it is possible to eliminate the disease) or palliative 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 a 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:
By matter
by drugs: pharmacotherapy, chemotherapy (also, medical therapy often means specifically pharmacotherapy)
by medical devices: implantation cardiac resynchronization therapy
by specific molecules: molecular therapy (although most drugs are specific molecules, molecular medicine refers in particular to medicine relying on molecular biology) by specific biomolecular targets: targeted therapy molecular chaperone therapy by chelation: chelation therapy
by specific chemical elements: by metals: by heavy metals: by gold: chrysotherapy (aurotherapy) by platinum-containing drugs: platin therapy by biometals by lithium: lithium therapy by potassium: potassium supplementation by magnesium: magnesium supplementation by chromium: chromium supplementation; phonemic neurological hypochromium therapy by copper: copper supplementation by nonmetals: by diatomic oxygen: oxygen therapy, hyperbaric oxygen therapy (hyperbaric medicine) transdermal continuous oxygen therapy by triatomic oxygen (ozone): ozone therapy by fluoride: fluoride therapy by other gases: medical gas therapy
by water: hydrotherapy aquatic therapy rehydration therapy oral rehydration therapy water cure (therapy)
by biological materials (biogenic substances, biomolecules, biotic materials, natural products), including their synthetic equivalents: biotherapy by whole organisms by viruses: virotherapy by bacteriophages: phage therapy by animal interaction: animal interaction section by constituents or products of organisms by plant parts or extracts (but many drugs are derived from plants, even when the term phytotherapy is not used) scientific type: phytotherapy traditional (prescientific) type: herbalism by animal parts: quackery involving shark fins, tiger parts, and so on, often driving threat or endangerment of species by genes: 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 by epigenetics: epigenetic therapy by proteins: protein therapy (but many drugs are proteins despite not being called protein therapy) by enzymes: enzyme replacement therapy by hormones: hormone therapy hormonal therapy (oncology) hormone replacement therapy estrogen replacement therapy androgen replacement therapy hormone replacement therapy (menopause) hormone replacement therapy (transgender) hormone replacement therapy (male-to-female) hormone replacement therapy (female-to-male) antihormone therapy androgen deprivation therapy by whole cells: cell therapy (cytotherapy) by stem cells: stem cell therapy by immune cells: see immune system products below by immune system products: immunotherapy, host modulatory therapy by immune cells: T-cell vaccination cell transfer therapy autologous immune enhancement therapy TK cell therapy by humoral immune factors: antibody therapy by whole serum: serotherapy, including antiserum therapy by immunoglobulins: immunoglobulin therapy by monoclonal antibodies: monoclonal antibody therapy by urine: urine therapy (some scientific forms; many prescientific or pseudoscientific forms) by food and dietary choices: medical nutrition therapy grape therapy (quackery)
by salts (but many drugs are the salts of organic acids, even when drug therapy is not called by names reflecting that) by salts in the air by natural dry salt air: "taking the cure" in desert locales (especially common in prescientific medicine; for example, one 19th-century way to treat tuberculosis) by artificial dry salt air: low-humidity forms of speleotherapy negative air ionization therapy by moist salt air: by natural moist salt air: seaside cure (especially common in prescientific medicine) by artificial moist salt air: water vapor forms of speleotherapy by salts in the water by mineral water: spa cure ("taking the waters") (especially common in prescientific medicine) by seawater: seaside cure (especially common in prescientific medicine)
by aroma: aromatherapy
by other materials with mechanism of action unknown by occlusion with duct tape: duct tape occlusion therapy
By energy
by electric energy as electric current: electrotherapy, electroconvulsive therapy Transcranial magnetic stimulation
by magnetic energy: magnet therapy pulsed electromagnetic field therapy magnetic resonance therapy
by electromagnetic radiation (EMR): by light: light therapy (phototherapy) ultraviolet light therapy PUVA therapy photodynamic therapy photothermal therapy cytoluminescent therapy blood irradiation therapy by darkness: dark therapy by lasers: laser therapy low level laser therapy by gamma rays: radiosurgery Gamma Knife radiosurgery stereotactic radiation therapy cobalt therapy by radiation generally: radiation therapy (radiotherapy) intraoperative radiation therapy by EMR particles: particle therapy proton therapy electron therapy intraoperative electron radiation therapy Auger therapy neutron therapy fast neutron therapy neutron capture therapy of cancer by radioisotopes emitting EMR: by nuclear medicine by brachytherapy quackery type: electromagnetic therapy (alternative medicine)
by mechanical: manual therapy as massotherapy and therapy by exercise as in physiotherapy and exercise therapy inversion therapy
by sound: by ultrasound: ultrasonic lithotripsy extracorporeal shock wave lithotripsy extracorporeal shockwave therapy sonodynamic therapy by music: music therapy neurologic music therapy
by temperature by heat: heat therapy (thermotherapy) by moderately elevated ambient temperatures: hyperthermia therapy by dry warm surroundings: Waon therapy by dry or humid warm surroundings: sauna, including infrared sauna, for sweat therapy by cold: by extreme cold to specific tissue volumes: cryotherapy by ice and compression: cold compression therapy by ambient cold: hypothermia therapy for neonatal encephalopathy by hot and cold alternation: contrast bath therapy
By procedure and human interaction
by counseling, such as psychotherapy (list of psychotherapies) systemic therapy by group psychotherapy[4]
by cognitive behavioral therapy by cognitive therapy by behaviour therapy by dialectical behavior therapy by cognitive emotional behavioral therapy
by cognitive rehabilitation therapy
by family therapy
by education by psychoeducation by information therapy
by physical therapy/occupational therapy, vision therapy, massage therapy, chiropractic or acupuncture
by lifestyle modifications, such as avoiding unhealthy food or maintaining a predictable sleep schedule
by coaching
By animal interaction
by pets, assistance animals, or working animals: animal-assisted therapy by horses: equine therapy, hippotherapy by dogs: pet therapy with therapy dogs, including grief therapy dogs by cats: pet therapy with therapy cats
by fish: ichthyotherapy (wading with fish), aquarium therapy (watching fish)
by maggots: maggot therapy
by worms: by internal worms: helminthic therapy by leeches: leech therapy
by immersion: animal bath
By meditation
by mindfulness: mindfulness-based cognitive therapy
By reading
by bibliotherapy
By creativity
by expression: expressive therapy by writing: writing therapy journal therapy
by play: play therapy
by art: art therapy sensory art therapy comic book therapy
by gardening: horticultural therapy
by dance: dance therapy
by drama: drama therapy
by recreation: recreational therapy
by music: music therapy
By sleeping and waking
by deep sleep: deep sleep therapy
by waking: wake therapy
See also
Biophilia hypothesis
Classification of Pharmaco-Therapeutic Referrals
Cure
Interventionism (medicine)
Inverse benefit law
List of therapies
Greyhound therapy
Mature minor doctrine
Medication
Nutraceutical
Prevention
Therapeutic inertia
Therapeutic nihilism, the idea that treatment is useless