For a while I used Qwerty for insert mode and Dvorak for command mode, but eventually I ended up using Dvorak for everything. My particular hand pain didn't show up until years after I took up Dvorak. My problem is mainly with my pinky fingers, and Dvorak actually seemed to be worse than Qwerty for me, so I've switched back to Qwerty.
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I'm sure anyone with the thoughtfulness to enjoy reading Hacker News can think of a solution to the Dvorak/Vim integration problem :)
For a while I used Qwerty for insert mode and Dvorak for command mode, but eventually I ended up using Dvorak for everything. My particular hand pain didn't show up until years after I took up Dvorak. My problem is mainly with my pinky fingers, and Dvorak actually seemed to be worse than Qwerty for me, so I've switched back to Qwerty.