When I suffered multiple fractures and dislocations to both hands in 1990, my hand surgeon suggested a fountain pen.  You don’t bare down on a fountain pen, as you do with a ball point pen, and the angle of your hand to the paper is less as well.  This results in less pressure to your thumbs at the sockets and, therefore, less fatigue and pain.  Over the years, I fell in love... and no pen has experienced the full depth of my appreciation more than this Montegrappa masterpiece.