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Is it only one arm that gives you issues?

I get various effects basically everywhere, but the biggest issue with M4/5, which I think would be similar with a gamepad is that the effort it takes to suppress the tremor feeds back and makes the tremor worse. I don't use my thumbs for game input much at all, now that I think about it.

M4/5 is the mouse im guessing?

oh, should have been more clear. I meant mouse buttons. 3 is middle click and 4 and 5 are the side buttons. M1/2/3 use a much different set of muscles than M4/5

interesting. So what would make it easier for you to play games on m&k?