The visitors stronger in the closing stages and looking more like potential winners before the 29,000 crowd.
The game had plenty of thrills but there was a lack of quality. Middlesbrough's Stewart Downing was the best player on view, despite a week of controversy.
The spotlight was on the England winger following a transfer request and a possible £15million move to Spurs.
Boro had rejected Spurs' overtures and stressed Downing would not be leaving the club during the January transfer window.
There was a great deal of pre-match speculation as to how Downing and the fans would react. The fans showed their support to Downing before a ball was kicked and the local hero responded with an excellent display.
It would have been easy for an unsettled Downing to stroll through the game but he showed wholehearted commitment.
Downing made the first scoring attempt after seven minutes when his 25-yard shot was saved by Marton Fulop. Sunderland hit back and El Hadji Diouf shot across the face of goal.
Almost immediately afterwards, Djibril Cisse should have done better when he headed wide.
The game was being played at a fast pace but there was no end product and neither goalkeeper was tested with defenders restricting the chances of forwards.
Just before the break, however, Middlesbrough went ahead with a classic move. Downing and Afonso Alves combined for the Brazilian to crash a powerful shot past Fulop.
Downing had spotted Alves in open space and the club's £12million record buy responded with a shot from the edge of the box.
Alves has struggled for form all season and this must have been a sweet moment for him.
Sunderland went all out for an early breakthrough in the second half with play held up following a clash of heads between Didier Digard and Carlos Edwards.
Edwards left the field for a spell with a cut head. Digard continued for a while but was forced to eventually go off following the clash of heads.
Sunderland made three substitutions with Andy Reid making an immediate difference. Another replacement, David Healy, helped Black Cats to draw level two minutes after his late introduction.
Kenwyne Jones had an easy scoring chance from close range after Healy laid on the pass.
In stoppage time a brilliant Tony McMahon tackle prevented Cisse snatching a dramatic winner for the visitors, who bossed the latter stages.