James Caan stars as author Paul Sheldon who has made a good living writing romantic novels based around the character Misery Chastaine.
However, fearful of being type-cast and tired of continuing the whole Misery saga, he pens his last ever "Misery" novel, hands his manuscript to his publisher and retreats to a remote cabin to write a more gritty novel about slum kids.
Once completed, he tucks his manuscript into his trusty old leather wallet, checks out and begins his car journey back to New York - home of his daughter and his publisher. However, a recent blizzard causes Paul to lose control of his car and he subsequently rolls it off the road and down a snowy embankment, sustaining multiple injuries as well as knocking himself unconscious.
We, the viewer, witness a passer-by free Paul from the mangled car with a crow bar and carry him off by way of a fireman's lift. We are given no clues as to the identity nor sex of the rescuer.
All this occurs in the opening scenes but the real story gets going as Paul awakes in a strange room, slightly concussed and also confused as a strange, rotund woman comes into focus, declaring herself to be his "Number one fan". She also declares herself to be a nurse but, due to the blizzard, she declares the roads to be closed and the phone lines down, making it impossible for an ambulance to get to her remote farm...
In spite of carer Annie Wilkes' inventiveness in stabilising Paul's legs via home made splints, she has a presumably illegal stash of various meds and equipment that she has hoarded since her days as a paediatric nurse.
Very soon into Paul's incarceration, he allows Annie to read his new manuscript - something he has previously never allowed due to his superstitions but makes an exception due to his acceptance that she saved his life. Upon reading a few chapters, Annie returns to Paul's room with lunch and, when asked for her opinion, she quickly becomes irate about the profanity within. So much so that she launches into a verbal faux pas whilst consistently spilling hot soup all over her victim and subsequently holding him culpable. Realising she's gone too far, she attempts to redeem herself by apologising and thereafter telling Paul that she loves him, before adding 'Your mind, that's all I meant' Almost at once, Paul realises he is in the company of a sociopath and from that point on he plays to her tune in a bid to make good his escape.
But escape is never easy when one has broken bones and when he shows signs of recovery he is disabled once again...