Two shrewdly-chosen elements separate this film from the typical Lifetime saga of a middle class white woman struggling to overcome a dire challenge. First is the way writer Patrick Tobin and director Daniel Barnz (the underrated “Beastly”) trust the audience, dispensing with the usual ten-minute “before” scene allowing us to fall in love with the main character before the bad thing happens. Claire (Jennifer Aniston) is already in a bad way when we meet her. The film is willing to take the risk of our not loving her, not even liking her, in part because it allows us to be drawn into the story because if America’s sweetheart Aniston is in the role, we know that this unhappy, uncooperative, woman must be worthy of our interest.

And that is the second element that elevates what could have been a soapy, formulaic story. Aniston, who also produced, gives a brave, vulnerable, nuanced, grimly humorous and deeply felt performance as Claire, a woman whose past we piece together only gradually as we also are discovering who she is now, how much she has lost, and, before she knows it herself, how much she has kept.

Claire lives in a lovely house with a pool and she has a housekeeper (Adriana Barraza, excellent as Silvana). We can see there was once more in her life but now it consists of therapy — group therapy (with Felicity Huffman as a leader not quite as sunny as she would like to seem), physical therapy (Mamie Gummer as the hydrotherapist who is losing patience), and the crucially important people who control access to the drugs (Lucy Punch as the cheerful if easily-misled keeper of the prescription pad). When finessing no longer works, Claire gets Silvana to drive her across the border to Mexico, where pharmacists are more persuadable and can also provide statues of the Virgin Mother with handy hiding places.

Claire has an ex-husband, Jason (the always-welcome Chris Messina, conveying worlds about what he and Claire once had in just a brief appearance). She has a handsome pool cleaner (just another form of drug). She has Silvana, who stays out of loyalty, pity, and limited other options. She also has Nina (a performance of great delicacy by Anna Kendrick), a fellow member of the Chronic Pain Workshop, whose sympathetic visits are problematic because she is not really there.

Nina committed suicide just before the movie starts, leaving a husband (Sam Worthington) and young son. Claire’s conversations with her are manifestations of her own dance with death, the numbness of drugged-out senses and overwhelming grief, or the ultimate choice to end it all.

We get small glimpses of who Claire once was and of how much of that she still has. When Silvana’s old friends behave like middle school Mean Girls, Claire knows exactly how to respond. With Jason and with a visitor played by William H. Macy, we see how much she has lost. Her humor can be grim, but it shows resilience. Her determination to get drugs may be focused on the wrong goal, but it shows her resolve. Aniston, who played the role with no make-up other than the scars applied to her face, shows with every grimace of pain, every attempt to contain a grimace, with movement that shows a world of understanding of physical pain, how fully she inhabits the character as Claire is learning how to return to her life.

Parents should know that this film has very strong language, some peril and violence, issues of loss and disability, substance abuse, sexual references and a sexual situation.

Family discussion: Why was Nina so important to Claire? Why did she go to see Roy?

If you like this, try: “The Good Girl,” “28 Days,” and “Inside Moves”