Sure, fine. The word "significant" doesn't make it or break it for me. I just think that by documenting that you acknowledge the patient is in some amount of pain, enough to merit treatment in some form, you dodge the whole accusation that you blew them off and accused them of faking. A lot of times when patients don't get the narcs they want, they try to then claim that we accused them of being drug addicts faking their pain. I think when you fall into that trap of allowing your chart to show that, or show contempt in the form of pejorative terms, then you open yourself up to the possibility that someone on a jury or medical board might try to hit you for treatment refusal or abandonment.
It's not a big deal. It's just how I view it when I'm not prescribing opiates in someone who clearly wants them. I don't want the chart to be consistent with the "He blew me off like I was crazy, a drug addict or making the whole thing up and cruelly refused to treat me!" Then, inevitably, out comes the piles of records from some guy they saw after your showed lots of sympathy, who piled on gobs of opiates, made all kinds of diagnoses and has a chart weeping with hand holding.
I don't care too much about the wording. I just want my chart to show I took the patient seriously, acknowledged they have a real issue (whatever it may be, whether it's fibromyalgia, a disc crushing a nerve or other) and offered to treat it, in some form. I think that's more defensible, in the face of a false accusation of abandonment or denying treatment to someone, than a chart that seems to drip of contempt for the patient or buzzwords hinting that they're malingering, faking their symptoms or manipulating, even if they might be. Because the problem is that malingerers and fakers get sick too.
I worked a lot of years in ED. And it seemed every time some doc put down in the chart that a patient was faking something, the patient either died or came back then next day in critical condition. We had one patient come in and the doc diagnosed him with pseudoseizures. And the guy absolutely did have an extensive documented history of faking seizures. He came in one day by EMS with a "pseudoseizure" and after work up, refused to leave. The doc had security remove the patient. The patient wasn't responding, so the doc told security the patient was faking and to take the patient in a wheelchair just past hospital property and let him go. So security did so, and dumped him off the wheelchair at the edge of hospital property and a passing car stopped and saw the guy laying down and called 911. He comes back in and was in status epilepticus. This guy that faked seizures decided to have a real one that day, and a real bad one. He ended up in the ICU and it became front page news, "Hospital dumps critically ill patient on side of the road." Moral of the story: Any time you put in a chart, explicitly or implicitly, that a patient is faking, your position is indefensible if that faker decides to get sick at any point in the near future. But if your charts always show you took the patient seriously and the opposite happens, that they turn out to be faking and manipulating, then so be it. No one dies or gets sued. (This applies to most cases, but not decisions as to whether or not to give patients opiates. Do not use this line of thinking as a reason to give people opiates, because trusting a faker and malingerer in that setting has real life negative consequences. But it does help you decide on your non-opiate diagnostic and treatment approach.)
Wear the white hat. It makes your decisions easier to defend and support.
