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Cook elbow macaroni in boiling salted water according to package directions.
Drain pasta in a colander and rinse with cool water for about 1-minute to stop cooking.
In a large bowl, combine pimento cheese, mayonnaise, relish, and sliced green onions and mix gently until combined.
Add the cooled pasta into the mixture and toss gently.
If needed, add milk (½ teaspoon at a time) until desired pasta salad consistency is achieved.
Taste the pasta salad and add seasoning (sugar, salt, black pepper) as desired.
Serve immediately or chilled about 1-hour before serving.
Store in an airtight container for up to 4-days.
If pasta salad thickens as it is stored, add a small amount of milk to thin the salad to your desired consistency prior to serving.