NCCIH’s New Clinical Director: Miroslav “Misha” Bačkonja

Bačkonja Develops Clinical Models to Sense, Combat Pain

BY ANNELIESE NORRIS, NCI

Miroslav “Misha” Bačkonja has been named the new clinical director of the NCCIH Division of Intramural Research, where he helps to oversee the NIH Pain Research Center.

Bačkonja, an international leader in clinical and translational pain research and an expert on pain’s underlying biological and neurobiological mechanisms, came to NIH in 2022 after serving as a professor in the Department of Anesthesiology and Pain Medicine at the University of Washington (Seattle). He also held leadership positions as professor of neurology at the University of Wisconsin (Madison) School of Medicine and Public Health and the University of Wisconsin Pain Treatment and Research Center.

“We are so fortunate to have Dr. Bačkonja take on the role of clinical director at NCCIH,” said David Shurtleff, NCCIH’s deputy director, acting scientific director, and acting director for the NIH Pain Research Center. “He brings a wealth of enthusiasm, knowledge, expertise, and experience to our clinical pain research program.”

No going back

Bačkonja grew up in what was formerly Yugoslavia and earned his medical degree from the University of Zagreb School of Medicine in Croatia. After he completed his studies, he was drawn to the United States and found himself at Creighton University (Omaha, Nebraska). Having initially started in family practice, Bačkonja recognized straight away that his passion was in neurology, and he discovered the challenges and his passion for pain management and research. After completing a residency and fellowship at the University of Wisconsin (Madison), Bačkonja stayed on as a faculty member.

Influenced by Jose Ochoa and Charles Cleeland while studying at the University of Wisconsin, Bačkonja became interested in human psychophysics and clinical pain research. He went on to receive a Mentored Clinical Scientist Research Career Development (K08) Award and spent five years working at the bench. From there, Bačkonja began conducting clinical research, which he enjoyed so much that “there was no going back,” Bačkonja said.

Tailoring pain treatment to individual patients

Bačkonja’s work largely focuses on psychophysics using quantitative sensory testing, which is the systematic study of sensory capacities of the sensory nervous system by determining behavioral responses to physical changes in sensory stimuli (PMID: 23742795). For example, if a person has gall bladder pain, they often feel shoulder pain, which is due to sensory convergence mechanisms. By “studying those [sensations] systematically, we can quantify pain so we can understand it better,” Bačkonja explained.

This quantitative sensory work dates back to the 18th century when German physiologist Moritz von Romberg (1795–1873) used bristles of horse hairs of varying thickness to study how people perceive sensation. Despite the longevity of psychophysics knowledge, pain treatment remains largely antiquated. This is something Bačkonja hopes we can remedy with modern biomedical approaches and tools.

Bačkonja is still learning the nuts and bolts of how the NIH works, and his vision as clinical director falls under the umbrella of translational pain research, from discovery to application in the clinic.

“There is no place like the NIH; it is really unprecedented, and I totally feel at home,” said Bačkonja. One ongoing quantitative sensory testing clinical trial he leads is the Clinical and Scientific Assessment of Pain and Painful Disorders, in which participants are exposed to sensations that are unpleasant, neutral, and pleasant.

Another project Bačkonja is working on is a human experimental model with the goal of matching specific treatments to different pain mechanisms and hence reach a pain treatment tailored to each individual patient. This work further aims to establish models of deep phenotyping and development of biomarkers for pain, which will translate into comprehensive profiling of individual patients with pain. 

For example, Bačkonja explained that when injecting 100mg of capsaicin into the skin epidermis, a person will experience sensitivity, known as hyperalgesia, in that area for three hours, which gives researchers a window of three hours to study response to stimuli and therapeutic interventions. 

According to Bačkonja, this experimental model offers neuroscientists the unique opportunity to study hyperalgesia, a phenomenon seen in patients with clinical pain but that can be induced temporarily without long-term sequela in healthy volunteers.

Teaching the next generation

Bačkonja has a passion for teaching and expanding the limited educational resources available in pain, both at the NIH and worldwide. He both lectures at and is part of the brain trust of the Interactive Pain Lecture Series, which seeks to bridge the gap between clinical work and basic science. His hope for this series “is to make pain research more accessible to learners to open the door to study pain as a career,” he said. 

The spring 2024 series wrapped up in June and the next series, now being created by a national team of pain researchers, clinicians, and educators, will begin early in 2025.

From trials to trails

When he is not working, you might find Bačkonja strolling along the Bethesda Trolley Trail. As an amateur ornithologist, Bačkonja smiles when discussing the trail, where he often can be found looking up at the trees and identifying birds. His favorite birds to spot there are the kingfisher, “because of its amazing flight pattern;” the northern flicker, “because its plumage;” and the gray catbird and northern mockingbird, “because of their song repertoire.”

Anneliese Norris, a scientist at NCI, is working on HIV dynamics and replication. In her spare time, she enjoys reading and building with LEGO^®.