Nå som ankelen er bedre, trenger hun ikke like mye smertestillende.

Nå som means now that in this sentence.

It introduces the reason/background for the main clause:

• Nå som ankelen er bedre = Now that her ankle is better

It is a very common way to connect a changed situation to a consequence.

Ankelen is the definite form of ankel:

• en ankel = an ankle
• ankelen = the ankle

Norwegian often uses the definite form for body parts when it is clear which one is meant. Here, we are talking about her ankle, even though her is not stated directly.

So ankelen er bedre naturally means the ankle is better / her ankle is better.

In Norwegian, it is very natural to say a body part or a condition is better when it has improved.

So:

• ankelen er bedre = the ankle is better / the ankle has improved

Bedre is the comparative form of god, but in practice it often works like improved in health-related contexts.

A more explicit version could be:

• ankelen har blitt bedre = the ankle has gotten better

But ankelen er bedre is shorter and very natural.

This is because Norwegian follows the V2 rule in main clauses: the finite verb usually comes in the second position.

The sentence begins with a fronted clause:

• Nå som ankelen er bedre

After that comes the main clause, and the verb must come first in that clause:

• trenger hun ikke like mye smertestillende

So the pattern is:

• fronted element + verb
  • subject

Compare:

• Hun trenger ikke like mye smertestillende.
• Nå som ankelen er bedre, trenger hun ikke like mye smertestillende.

Both are correct; the second one has inversion because something else comes first.

In a normal main clause, the finite verb comes before ikke, and the subject usually comes before ikke too.

So the order is:

• trenger hun ikke

not

• trenger ikke hun
• ikke trenger hun (unless for special emphasis)

This is a standard Norwegian word order pattern:

• Hun trenger ikke det.
• I dag trenger hun ikke det.
• Nå som ankelen er bedre, trenger hun ikke det.

Like mye means as much.

So:

• ikke like mye = not as much

This is a comparison with an earlier amount that is understood from the context.

The sentence means she does not need the same amount of pain medication as before.

Compare:

• Hun trenger mye smertestillende. = She needs a lot of pain medication.
• Hun trenger like mye smertestillende som før. = She needs as much pain medication as before.
• Hun trenger ikke like mye smertestillende. = She doesn’t need as much pain medication.

Because smertestillende is being treated as an uncountable amount here.

In Norwegian:

• mye is used with uncountable nouns
• mange is used with countable nouns

So:

• mye smertestillende = much / a lot of pain medication
• mange tabletter = many tablets

Even though English often says painkillers as a plural count noun, Norwegian often uses smertestillende more like a mass noun: pain medication.

Here, smertestillende means pain medication or painkillers.

Literally, it comes from something like pain-relieving. It can function as:

• an adjective: smertestillende medisin = pain-relieving medicine
• a noun-like word on its own: smertestillende = pain medication / painkillers

In everyday Norwegian, using smertestillende by itself is very common.

Yes, often you could.

• Hun trenger ikke like mye smertestillende.
• Hun trenger mindre smertestillende.

Both can mean roughly She needs less pain medication.

The difference is mainly in emphasis:

• ikke like mye = not as much, compared with before
• mindre = less

So the original sentence highlights the comparison with an earlier situation a bit more clearly.

Trenger is the present tense of å trenge = to need.

So:

• å trenge = to need
• trenger = need / needs

Norwegian uses the present tense here just as English does:

• hun trenger ikke = she does not need / she doesn’t need

There is no special progressive form here.

Yes, it is standard to use a comma here.

The first part is a subordinate clause:

• Nå som ankelen er bedre

Then comes the main clause:

• trenger hun ikke like mye smertestillende

When a subordinate clause comes first, Norwegian normally separates it from the main clause with a comma.

So this punctuation is correct and expected.

Not explicitly, but it is strongly understood.

The sentence says:

• ankelen = the ankle
• hun = she

In context, listeners naturally understand that it is her ankle. Norwegian often leaves this kind of possession implicit when it is obvious from the situation, especially with body parts.

So English may prefer her ankle, but Norwegian can simply say ankelen.