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Dr Sharmila Khot

Dr Sharmila Khot

Honorary Senior Lecturer

School of Psychology

Email:
khots@cardiff.ac.uk
Location:
Cardiff University Brain Research Imaging Centre, Maindy Road, Cardiff, CF24 4HQ

I am a Consultant in the Department of Anaesthesia, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board. I work within the Division of Perioperative Medicine. I am currently Clinical Research Fellow (Drugs and Physiology) in the Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University. My associated research group is the Imaging Cerebral Physiology group at CUBRIC.

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

My teaching activity as Honorary Senior Lecturer, School of Medicine, CU (2008-2013), covers 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 several Student Selected Projects most of which have been presented in local and National meetings.

Undergraduate and postgraduate teaching: I contribute to the MSc in Liaison Psychiatry module, Cardiff University. I am an educational and clinical supervisor. I am a Course Director for the postgraduate simulation-based safe sedation course and pain management course. I regularly teach pain management and pain physiology at the Welsh anaesthesia courses.

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.

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, physiological and methodological aspects of preclinical and clinical pain research using advanced imaging methods.

I am also involved in evaluating brain mechanisms of sedation including electrical, metabolic and functional connectivity underlying GABAergic and non-GABAergic sedation, and impact on memory and anxiety. 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√§. We are currently developing a research group collaboration with other similar groups for further research in this area.

Neuroscience: Pain is a complex bio-psycho-social phenomenon involving peripheral and central mechanisms. Anxiety and pain are closely linked with overlapping physiological 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 encoding transition from acute to chronic pain utilising non-invasive magnetoencephalography (MEG). We plan to assess the nociceptive specific encoding of the sensory and affective components of a phasic and tonic painful stimulation in healthy volunteers.

Fatigue is experienced by people suffering from several neurological and non-neurological conditions. I am also interested in exploring the cerebral energetics/metabolism that underpins fatigue experienced in several disease models including rheumatoid arthropathy and multiple sclerosis. The aim of this research is to explore a common pathophysiological putative central mechanism for fatigue in various non-neurological conditions 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

Co-Investigator Tofacitinib on pain processing in Rheumatoid (ToPPRA)

Total award: £331,202

CUBRIC publications

Whittaker J, Khot S, Murphy K (2018) Magnetic Resonance Imaging to understand cerebral autoregulation. Comments on CrossTalk 34: Dynamic cerebral autoregulation should be quantified using spontaneous/induced blood pressure fluctuations On the choice of optimal stimulus type for assessing dynamic cerebral autoregulation. The Journal of Physiology 2018 0.0 pp 1-8https://wol-prod-cdn.literatumonline.com/pb-assets/assets/14697793/Crosstalk%2034%20comments.pdf

Whittaker J, Bright M, Driver I, Babic A, Khot S, Murphy K (2017) Changes in arterial cerebral blood volume during lower body negative pressure measured with MRI. Neuroimage, http://dx.doi.org/10.1016/j.neuroimage.2017.06.041

Merola A, Germuska MA, Warnert EAH, Richmond L, Helme D, Khot S, Murphy K, Rogers PJ, Hall JE, Wise RG (2017)Mapping the pharmacological modulation of brain oxygen metabolism: the effects of caffeine on absolute CMRO2 measured using dual calibrated fMRI, NeuroImage, http://dx.doi.org/10.1016/j.neuroimage.2017.03.028

Germuska M, Merola A, Murphy K, Babic A, Richmond L, Khot S, Hall JE, Wise RG (2016) A forward modelling approach for the estimation of oxygen extraction fraction by caliberated fMRI, NeuroImage 139, pp. 313-323

Other publications

Jansen V, Hiom S, Khot S: 062 Evaluation of the Service provided to Neuropathic Pain Patients Treated with Gabapentin Gel, Gabagel™ British Journal of Pain 2016 10(2) Supplement1

Hiom S, Patel GK, Newcombe RG, Khot S (2015) Severe Postherpetic Neuralgia and Other Neuropathic Pain Syndromes Alleviated by Topical Gabapentin. Br J Dermatol. Jul;173(1):300-2.

Hiom S. Khot S, Mogford S, Hart C, Patel G, Roberts G, Martin C, Newcombe R (2015) Topical delivery of gabapentin (Gaba Gel ™) for neuropathic pain: A proof of concept study. International Journal of Pharmacy Practice, 23 (S2), p. 46

Khot S and Hopkins S (2015) Commissioning of Services Chronic Pain Wales, Core Standards for Pain Management Services in the UK, Faculty of Pain Medicine, Royal College of Anaesthetists 2.2, pg14-17 http://www.rcoa.ac.uk/system/files/FPM-CSPMS-UK2015.pdf

Khot S and Shortland G (2014) Appendix 2; Case studies: a How would prudent healthcare affect the treatment of ‘chronic pain’? pages 38-42 in Bradley P & Wilson A (2014) Achieving prudent healthcare in NHS Wales, Cardiff: Public Health Wales

http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/Achieving%20prudent%20healthcare%20in%20NHS%20Wales%20paper%20Revised%20version%20%28FINAL%29.pdf

Khot S, Morgan C Ll, Kadambande S, Poole CD (2014) Use of 5% lidocaine medicated plasters for the treatment of pain in routine hospital practice: patient reported pain, functioning and satisfaction. Current Medical Research & Opinion May, 1-6

Khot S, Lewis R (Autumn 2014) Pain in Wales: Past, Present and Future. Transmitter, Newsletter of the Faculty of Pain Medicine-Royal College of Anaesthetists, page5-6

Khot S, Flory S, Tahir T (June 2013) A simulation-based course for pain management: Improving skills in the utilisation of bio-psychosocial formulation in non-psychiatrists. Journal of Psychosomatic Research Volume 74, Issue 6, Pages A1-A2, Page 549

Khot S (Spring 2013) Pain In Wales, Transmitter, Newsletter of the Faculty of Pain Medicine, Royal College of Anaesthetists, page 10.

Khot S (2011) Synaptic Plasticity in Pain; Book Review, in Anaesthesia: Volume 66, Issue 5, pages 415–416, May 2011-Wiley Online Library Synaptic Plasticity in Pain M.Malcangio (Ed.) Springer-Verlag , New York ; July 2009

Ghei A, Khot S (2010) Pain Management in patients with head and neck carcinoma. Otorhinolaryngology Clinics January-April 2010 Volume 2 Number 1 pg 69-75 ISSN 0975-444X