Dr Sharmila Khot

Publication

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Research

My specialist clinical interests are in pain management, including acute postoperative pain, pain and fatigue in systemic inflammatory conditions such as Rheumatoid Arthritis (RA) and in other chronic persistent pain conditions including fibromyalgia.

My research interests cover clinical and physiological aspects of preclinical and clinical pain research using advanced imaging methods.

I am Wellcome Trust funded for pharmacological sedation workstream of the WTSA project evaluating brain mechanisms of sedation including electrical, metabolic and functional connectivity underlying GABAergic and non-GABAergic sedation. I am interested in both forward and reverse translational research.

Clinical: I am a Co-Investigator in a clinical neuroimaging pain study assessing the effect of Tofacitinib (JAK-STAT inhibitor) on Pain processing in rheumatoid arthritis. Abnormal pain processing in the brain is associated with severe pain and disability including fatigue and sleep disturbances in RA. Cytokines have been implicated in the pathophysiology of abnormal pain processing. Effective inhibition of cytokines may lead to rapid restoration of pain processing and more substantial reduction in pain as well as other symptoms. However specific neural mechanisms of pain or fatigue and response to biological treatments remain unknown. Our research utilises cutting edge brain imaging techniques in order to address this gap in our knowledge.

Drug research: Through a process of clinical audit, research and publications I have successfully led the development of a market for a ‘specials product’: topical Gabapentin cream, manufactured in a local NHS pharmaceutical unit. My group has validated the existing formulation and trademarked the product; Gabagel. 

Neuroscience: Pain is a complex bio-psycho-social phenomenon involving peripheral and central mechanisms. 

A human experimental model for chronic pain remains difficult to characterise due to the sensory, motivational and cognitive experiences that define pain. Chronic pain presents with an apparent shift towards greater affective and cognitive influences during individual pain experience. We aim to explore the cortical mechanisms of chronic pain utilising non-invasive magnetoencephalography (MEG). 

Fatigue is experienced by people suffering from several neurological and non-neurological conditions. I am interested in exploring the cerebral mechanisms that underpin fatigue experienced in several disease models utilising advanced neuroimaging techniques developed in CUBRIC.

Methodological: I am interested in the development of functional neuroimaging for clinical applications such as drug development, exploring mechanisms of drug activity with sedation, e.g. GABAergic/non-GABAergic and in clinical pain conditions. I have contributed to the development of advanced methods of functional and structural neuroimaging to characterise anatomical and functional changes in the development of neuroimaging markers of drug effects.

Research Collaborators

Prof Richard Wise, Head of MRI, CUBRIC, School of Psychology, CU

Prof Krishna Singh, Head of Human Electrophysiology, CUBRIC, School of Psychology, CU

Prof Ernest Choy, Head of Rheumatology and Translational Research-School of Medicine CU

Prof Kevin Murphy, School of Physics and Astronomy, CUBRIC, CU

Dr Girish Patel, Consultant Dermatologist, Cardiff and Vale UHB and Honorary Senior Lecturer, European Cancer Stem Cell Research Institute, Haydn Ellis Building, CU

Dr Sarah Hiom, All Wales Specialist Pharmacist, R and D, St Mary’s Pharmaceutical Unit, Cardiff and Vale UHB

Dr David Nunns, Consultant in Obstetrics and Gynaecology, Nottingham University Hospital NHS Trust.

Dr Neeraj Saxena, Consultant in Anaesthesia and Pain Medicine, Cwm Taf University Health Board, Clinical Senior Lecturer, CUBRIC, Visiting Professor University of South Wales.

Dr Kyle Pattinson, Senior Clinical Research Fellow, Wellcome Centre for Integrative Neuroimaging, Consultant Anaesthetist and Associate Professor, Nuffield Department of Clinical Neurosciences, Oxford

Grants

2018 ASPIRE Pfizer Rheumatology and Inflammatory Bowel Disease Research Awards

Teaching

My teaching activity as Honorary Senior Lecturer, School of Medicine, CU (2008-2013), covered several aspects of teaching, from one-to-one sessions as personal tutor to developing innovative teaching techniques locally and at national courses. My audience includes medical students, clinical staff, and undergraduate and postgraduate students and colleagues from various specialities including psychiatry, physiotherapy, rehabilitation medicine, neurology and general practice.

Undergraduate teaching: I teach on the second-year medical school, case 14 low back pain module. This includes clinical skills teaching as well as lumbar puncture tutorial at the school of biosciences. I have previously taught on the Professionalism and Diversity module (old curriculum) including the interpreter led immersive learning sessions.  I have been an examiner for final MBBS and supervise Student Selected Projects most of which have been presented in local and National meetings.

Clinical specialist teaching: I was appointed Regional Advisor in Pain Management for Wales for the Royal College of Anaesthetists for two 3-year terms, and a member of the Anaesthesia Speciality Training Committee, as well as the Welsh Anaesthesia advisory group as representative for Pain Medicine. I developed the structured training in Pain Medicine in Wales.

I have been invited Lecturer at several national study courses for anaesthetists most notably on the Training the Trainers: Small Group Teaching techniques at the Association of Anaesthetists of Great Britain and Ireland.

I continue to teach an integrated biopsychosocial approach to pain management and pain physiology to all levels of anaesthesia and GP trainees.

Biography

Undergraduate Education: MBBS

Postgraduate Education: FRCA, FFPMRCA, MD Anaesthesia, Diploma in Anaesthesia, MSc Pain Management Cardiff University

Employment:

2004-present: Consultant in Anaesthesia, Pain Medicine and Intensive Care, Cardiff and Vale University Health Board

April 2019-present: Clinical Research Fellow (Drugs & Physiology), CUBRIC, CU

2013-2018: Honorary Senior Lecturer, CUBRIC, School of Psychology, Cardiff University (research secondment)

2007-2013: Honorary Senior Lecturer in Medical Education, School of Medicine, Cardiff University (undergraduate and postgraduate teaching, simulation education, course development and training)

Professional memberships

• Fellow of the Royal College of Anaesthetists of Great Britan and Ireland
• Fellow of the Faculty of Pain Medicine, Royal College of Anaesthetists
• British Pain Society