The confined space pressure cooker thriller occupies a peculiar corner of cinema. Without the sprawling safety net of spectacle, this is a niche genre where directors prove their ability to sustain tension, pacing, and creativity within four walls. From Hitchcock’s tightly-wound classics to modern nightmares like Don’t Breathe and Hush, what distinguishes successful entries isn’t originality but execution. Forget the far-off locales of location shooting. Often, the most heart-pounding experiences come from a single location, a tiny cast, and one desperate character with nowhere to run. James Villeneuve’s gnarly shocker Pins and Needles answers this challenge by delivering an under-the-radar Canadian-made indie that demonstrates how rough edges can enhance rather than diminish a scrappy thriller’s impact.

Max (Chelsea Clark), a diabetic biology grad student, is heading back from a campus wellness retreat with her awkward friend Harold (Daniel Gravelle, Scary Stories to Tell in the Dark) when he drops a surprise on her. He’s agreed to offer a lift to the sketchy Keith (Damian Romeo, Fear Street: Prom Queen), and before she can object, he’s a third member of their rideshare. Things take a turn when an ill-timed tire blowout strands them in the middle of nowhere but within walking distance of a large, modern suburban home. Out of range of the nearest cell tower, Max heads over to see if the homeowners have a phone and, finding the front door unlocked, enters. She’s about to call back to the guys when she sees the seemingly helpful couple, Frank (Ryan McDonald, Becky) and Emily (Kate Corbett, IT: Chapter Two), pull up to greet them.

That’s when the nightmare begins.

Unfortunately for the traveling trio, they’ve encountered a couple whose mid-century charm and open-concept aesthetic masks a secret: they’re running a DIY blood-harvesting operation from the comfort of their basement. By their count, two perfect candidates for their latest study have wandered onto the grounds of their laboratory and won’t be missed. They had no idea a third passenger was with them. That’s good news for Max, who avoids being seen by Frank and Emily, only to realize she’s left behind her insulin in the car, forcing her to sneak back inside the garage to the car (which has been brought to the house) and try not to become the next specimen on their slab. As the couple goes about their grisly business, Max must navigate their unfamiliar home and remain undetected until she can make a run for it or gain the upper hand… if she has the strength.

It’s a familiar premise, but what’s different here is that writer/director Villeneuve (whose serial killer comedy Vicious Fun made waves on Shudder) excels at creating the old feel urgent again, transforming Pins and Needles from a paint-by-numbers escape thriller into something with ambitions of being more complex. The majority of the film unfolds wordlessly, avoiding cheap tricks and relying entirely on Clark’s physicality and expressive features to convey Max’s arc from confusion to terror to determined resourcefulness. That’s a big ask for any actor, but her performance is raw, selling Max’s escalating panic and clever ingenuity without resorting to obvious scream-queen theatrics. You root for her because she never stops thinking—even when the odds stack against her.

Unfortunately, McDonald and Corbett struggle with their roles as the killer couple, aiming for creepy-casual weirdness but falling somewhere between Stepford Wives wackiness and Instagram-influencer sadism. Their new-age nonsense dialogue alone makes them easy to hate, but too often, it veers hard into cartoonish caricature. Their chipper menace is watchable but inconsistent, which clashes with the realism Clark works exceptionally hard to maintain and undercuts the tension Villeneuve pulls together. Overall, they feel more like reality show rejects turned serial killers than fully realized threats.

Pins and Needles isn’t revolutionary filmmaking that redefines genre conventions, but Villeneuve’s understanding of how to build tension in tight quarters makes it refreshingly effective throughout. There’s a scruffy aesthetic in Pins and Needles, which feels authentic rather than perfectly polished, creating an atmosphere where genuine danger lurks behind everyday suburban facades. Taking place mostly during crisp daylight, this choice by director and cinematographer Bob Lyte makes the horror that unfolds feel more invasive and less escapist. Steph Pringle’s practical effects are gruesome enough to make you wince and restrained, not to derail the tone. The violence, when it arrives, is matter-of-fact, not indulgent.

The film’s use of Max’s diabetes as a narrative device is mostly well-integrated, though these kinds of limiting conditions can risk feeling like a screenwriting cheat to keep her tethered to the house. Thankfully, it’s handled with restraint that doesn’t feel exploitative or melodramatic. Her medical predicament serves multiple narrative functions beyond simple plot mechanics, becoming part of a larger thematic element that involves vulnerability in subtle ways, providing another way to examine the story. It’s not essential to the film’s success, but it gives Max’s choices added weight.

The biggest hurdle Pins and Needles doesn’t manage to fully clear is its tendency to overstay its welcome by about one or two hallway-dodging sequences. At 81 lean minutes, it still somehow feels slightly stretched, with Max darting around the house just a few too many times without changing the rhythm. A couple of tighter edits around Max’s hide-and-seek or one more major twist within the cat-and-mouse play could have elevated the back third.

These kinds of small-scale shockers can easily slip through the cracks, lost in the digital shuffle of a market oversaturated with similar-sounding projects. But when they stick the landing with confidence like this one mostly does, they deserve to be sought out and celebrated. While not every element succeeds, some character motivations feel contrived, and the beginning is all useless expository filler; the film possesses that intangible quality that marks emerging talent. The emotional impact stems from Clark’s vulnerability rather than elaborate set pieces, making us genuinely fear for Max because she feels real, not because the situation is particularly unique.

Pins and Needles might not keep you fully on them the whole time, but you’ll grip your couch on a few occasions (especially for a terrific jump scare). This rough-hewn Canadian thriller proves that modest ambitions, when executed with skill and sincerity, can generate genuine thrills—and serves as a reminder to even the most jaded critic to keep an eye on your meds next time you go off the grid.