It's the first. Though I did have hand therapy, I am nervous to rearrange my hotbar. Is it really more optimal to change it?Does your cramping have to do with the gymnastics of performing the class to its and your max? Or does it occur even if you do something more casual like killing mobs on the overworld while doing other stuff?
If it's the first, you could try to rearrange your hotbars or play a less action intensive class. Believe it or not some set ups are hellish to work with. Mine for example, people cringe at it, but I'm used to use "the claw" to perform actions with the D-pad while moving.
If it's the second, I'd go to the doctor and search for any accessories that could help you game safely. For real, your doctor is your best friend in this. You could be developing carpal tunnel syndrome and you would only hurt yourself further if you persist in gaming as hard as you are now.
My two cents.
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