I bought a keyboard.io model 01 recently, because I was desperate (and I'd been intrigued by its programmability for a while). I bought a vertical mouse (cheap Anker) at the same time.
I've had RSI issues in the past, but this spring (when I bought those two), I was in intense pain for days at a time, even when not at my desk. Otherwise good ergonomic setup: external monitor, adjustable desk and good chair, etc.
I'd suggest you at least take small steps to improve/optimize your ergonomics before you have a problem. It really does suck to be in pain like that, especially when doing your work, which you have to do to pay the bills, makes it worse. I was looking forward to weekends just for some relief.
For what it's worth, having a programmable keyboard is super cool even without the ergonomic benefits. It's just fun to tinker and optimize your layout, macros, etc.