This was the feature film debut for director Fraser C. Heston, who had played the infant Moses in The Ten Commandments (1956). During the filming, he took Max von Sydow (who played Jesus in The Greatest Story Ever Told (1965)) aside to discuss how he would play the upcoming scene. One observer noted, "That's something you don't see every day - Moses telling Jesus how to play the devil."
Stephen King's original novel also featured a return appearance by Ace Merrill, the bully played by Kiefer Sutherland in Stand by Me (1986).
The setting of Needful Things is a fictional town called Castle Rock, Maine - as in Stephen King's novel. The distribution company Castle Rock was named after it when it released Stand by Me (1986). Castle Rock was also the setting for The Dead Zone (1983), Cujo (1983), and The Dark Half (1993). It was also the setting for Stand by Me
Brian Rusk's mother appears in the longer, 3 hours version. In her sidestory she purchases sun glasses worn by Elvis Presley. She can still be seen in the cut version of the movie at the end wearing the sun glasses.
Sheriff Alan Pangborn, played here by Ed Harris, also appears in The Dark Half (1993), released earlier the same year, in which the part is played by Michael Rooker.