In this darkly humorous thriller, James Caan portrays Romantic novelist Paul Sheldon, famously renowned for his trademark character, the film's namesake 'Misery' Chastaine. shortly after finishing his latest book, he drives of back to New York from the Silver Creek lodge. After a while, his car swerves off the icy road in a blizzard. In the car, he has a flashback in which he is talking to his agent (portrayed by Lauren Bacall) about his last Misery book. He is rescued by nurse Annie Wilkes (Kathy Bates) who takes him back to her house for two days and reveales that she is his number one fan, hence the infamous quote "I'm your number one fan". When Annie asks if she can read his new book (in manuscript form) she proves to be more than a little eccentric when she lashes out in a fit of rage over the swearing in his book. When she leaves the room he seems fraked out and looks like he wants to leave quickly. The next day, Annie brings home a copy of the final Misery book and over the days reveals how many pages she has read. During which, she introuces him to her pet sow, Misery.
The following night, she nearly kills him over the fact that he has killed Misery in his final book, tells him that she never called the local hospital (which she said she had) and threatens to kill him if anything happens to her. He immediately tries to escape but fails. The next day, Annie seems happy and tries to persuade him to burn the manuscript to which he seems reluctant. Later, she reveals she wants him to write a new book in which Misery comes back to life. When he sees a hairpin on the floor, he has an idea to buy time, he asks Annie to buy some different paper because his current paper smudges, to which she responds with another fit of rage. Whilst she is out shopping, Paul uses the hairpin to unlock his bedroom door and escape. However, he soon finds out that the front door is locked as well. He makes a visit to her living room and medicine closet. In the living room he accidentally knocks a small ceramic penguin off the table and puts it back the wrong way (this will become important later). He also realises that Annie's phone is a fake one, cancelling his chances of contacting the outside world. In the medicine closet, he takes some of the pills the Annie had been giving him for his fracture. He also tries to escape through her back door in the kitchen but cannot open it (I forgot to mention that he was bedridden for a few days and currently in a wheelchair). Soon, he hears Annie returning and immediately races back to his room. Fortunately, he gets back to his room in time just when she opens the door. She gets him back into bed and gives him a notepad and his pills (which he pretends to swallow).
The following night, he saves up a lot of powder from the pills. In the morning, an argument starts between Paul and Annie about the book, which escalates into a humorous fit of rage about her growing up in Bakersfield watching chapter plays. Meanwhile, the local authorities find Sheldon's '65 Mustang buried in the snow. When Annie reads some of Paul's new manuscript she responds happily. Paul requsts that Annie have dinner with him to celebrate Misery's return. At the dinner, Paul makes a toast to Misery's return but asks if she has any candles. Whilst Annie is looking for them, Paul puts the powder in her wine. When she returns she almost makes the toast but drops her drink in the process, ruining Paul's plan.
The next scene shows a line of clips of Paul writing the book. In the last clip, Annie gives him his pills and talks about committing suicide. When she leaves the house, he goes out of his room again and reads her scrapbook. It includes many newspaper clippings, revealing that she killed her father, her college roommate and many patients in hospitals. He grabs a knife from the kitchen and wheels himself to his room. Later, he awakens to the sight of Annie as she forcibly sedates him. In the morning, she ties him to the bed and reveals that she knows that he has been out of his room (the scrapbook, the ceramic penguin, the hairpin). Then, she 'hobbles' him (puts a block of wood betwen his feet and hits them with a sledgehammer)
In the next scene, 'Buster' the local sheriff sees an emotional outburst in the town and researches her history. Later, he pays a visit to her house to look around. When he leaves, he hears a noise and goes back inside to find Paul in the basement and is shot by Annie. When she says she wants to kill him then herself, he requests finishing the book first. later, he is writing the book and requests 3 things: a cigarette, matches, and Dom Perignon champagne. When Annie returns, he also requests two glasses. whilst she is out of the room, he pours flammable liquid onto the manuscript and burns it, which escalates into a brawl resulting in Annie's death.
18 months later, Paul is seen in a restaurant with his agent, refusing to write a book about his experiences. He mistakes a waitress for Annie in a haunting vision as she repeats Annie's line: "I'm your number one fan".