DJ -limited response but I use Wacom pen on a touch laptop and have just orders said pad as a mouse substitute. I am a fan. I would take a pragmatic approach to this and go back to basics on a 1-1 basis. I suspect that because we are all tied to our pc's the graphics guys are getting no rest at all - filling down time from the drawing board with office admin or games. It may also be that using the touchpad and looking up at the screen caused additional tension in the arm, or more likely the desk isn't the right height for pen strokes as it is 'keyboard user' standard (ergonomist please step in). Is there any way of sketching directly onto the laptop (r lap) (eg ipad or window surface type machines). This would allow a much more natural posture to be used. Perhaps try one just to see if there is a difference - might even increase production. Would the culture of the organisation welcome some form of massage therapy or something similar? These are expensive people to employ and productivity process may need some maintenance!