In this darkly comedic thriller, James Caan takes on the role of Paul Sheldon, a renowned romantic novelist celebrated for his beloved character, the film's titular "Misery" Chastaine. After completing his latest manuscript, Paul embarks on a journey back to New York from Silver Creek Lodge. During this treacherous trip, his car careens off the icy road amidst an unforgiving blizzard. In a moment of introspection, he recalls a conversation with his agent (portrayed by the legendary Lauren Bacall) regarding his last Misery novel.
Rescued from the wreckage by the seemingly kind-hearted nurse Annie Wilkes, played by the talented Kathy Bates, Paul finds himself recuperating in her home for several days. It's here that Annie reveals her fervent admiration for Paul, enthusiastically declaring, > "I'm your number one fan." However, as Paul shares his new manuscript with Annie, it becomes painfully clear that her admiration has taken a darker turn. A violent outburst follows when she confronts him about the language in his book, leaving Paul feeling trapped and bewildered.
As Annie's obsession deepens, she unveils that she has meticulously read each page of his final Misery book and presents him with her pet pig named Misery. That very night, a shocking revelation unfolds when Annie discovers that he has killed off Misery in his manuscript. Fueled by rage and an unstable sense of loyalty, she reveals that she has not contacted any medical help as promised, and issues a chilling threat against Paul's life should anything happen to her.
Desperate to escape his increasingly perilous situation, Paul devises a plan using a hairpin he discovers on the floor, asking Annie for different paper due to smudging issues. While she is away shopping, he attempts to unlock the bedroom door to flee, only to find that the front door is secured as well. In one of his frantic explorations, Paul accidentally disrupts a small ceramic penguin on the table, an incident that foreshadows critical developments later on. To his dismay, he soon realizes that Annie's phone is a fake, cutting off all hope of contacting the outside world.
As his captivity drags on, Paul discovers disturbing truths about Annie's past in her scrapbook, including her unsettling history of violence. The tension escalates when Annie discovers that he has been out of his room, leading to her brutal punishment known infamously as 'hobbling.'
Meanwhile, Buster, the local sheriff played by Richard Farnsworth, begins to piece together Annie's history and the alarming circumstances surrounding Paul’s disappearance. His investigation culminates in a visit to Annie's home, but when he uncovers the truth, his life hangs in the balance as Annie's malevolence reaches terrifying heights.
In a gripping finale, Paul tricks Annie into letting her guard down, igniting a fierce confrontation that results in a catastrophic struggle for survival. Ultimately, 18 months later, we find Paul in a restaurant with his agent, grappling with the traumatic legacy of his ordeal and refusing to pen a book recounting his harrowing experiences. As he moves through his turbulent memories, a waitress eerily echoes Annie's haunting words: "I'm your number one fan," leaving him—and the audience—wondering about the lasting grip of trauma.
